HomeMy WebLinkAboutXR2022-2375 - Permit ApplicationPrint itom, Worksheet for Combo Building & Solar Permit pplication
h t B f N City of -Building Division 42�?_� --- 75 - 1�
F- Comm'I F- Residential t�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading r-Drainage F_ Elec r- Mech F- plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) [_ Flood r Fire F_ Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use S Const Type Fvs
# Stories # Units (if Res)
I f F
.. .. ..... .. -------- .. .... .. ..... . ......
Valuation $
Material/Labor
0 cD a
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New/Add SFJ Remodel SFj--(,-06i:— Garage/New/Addf
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
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City F -_._ _ ___.. __ .State zip 7L Telephonel, --Cf q 7q L3
APPLICANT'S NAME Last >Orw,-C First
Applicant's Address Applicant's E-mail Address
City State F Zip Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip Telephone
ENGINEER'S NAME Last First Lic. No.l.
Engineer's Address Engineer's E-mail Address
City State Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. C) No. Class
C, C_ ,,, F F
Contractor's Address Contractor's E-mail Address
City F—StateF__ Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $