HomeMy WebLinkAboutX2022-0187 - Permit Application1 Print Form _ Work,,,3homet for Combo Building & Solar Permit Application
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) [i Flood r; Fire [i Liq j! Landslide [N/A
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Description of Work
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New/Add SF�— J Remodel SF Garage/New/Add
OWNER'S NAME
Owner's Address
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Owner's E-mail Address
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Floor Suite No
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Use Const Type
# Stories # Units (if Res)7
Valuation $
Material/Labor �� (,l
APPLICANT'S NAME Last t"
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Applicant's Address
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CityvS}� —J State
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Applicant's E-mail Address
Zip 2(o Telephone (� 102C&I
ARCHITECT/DESIGNER'S NAME Last
--__---...1 First-7 Lic. No.
Architect/Designer's Address
City .--- - ---- -- -- — — ---� State
Architect/Designer's E-mail Address
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zip Telephone
ENGINEER'S NAME Last �j �, First Lic. No.
Engineer's Address
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City State
CONTRACTOR'S NAME/COMPANY
Contractor's Address ^
City S State
Engineer's E-mail Address
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Lic. No. 1�p(c{ (� Class��
Contractor's E-mail Address
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Zip Telephone (7t �)352_uz
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
PERMIT NO. ��
PLAN CHECK NO.