HomeMy WebLinkAboutX2021-2806 - Permit ApplicationPrint Form' Worksheet for Combo Building & Solar Permit A licat'
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Mech Num
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(� Flood r Fire Liq r Landslide N/A Floor
Suite No
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Use Const Type
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d SF Remodel SF �---�_ �
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--� Material/LaborJER'S NAME
Last
E. PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �' ~ awo(o
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Drainage t��lec
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ner'sAddress I First � IQ4 L,
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PLICANT'S ruamr
Owner's E-mail Address
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Applicant's E-mail Address
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City State I �fS
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ity
State I e �;
ONTRACTOR'S NAME/COMPANY
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Lic. No.
Engineer's E-mail Address
Zip 12� Telephone -71 +' jq--i . a» rl
6,T��- N . o.j .._r
)ntractor's Address Lic
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BACKS REAR SETBACKS FRONT
3ACKS LEFT SETBACKS RIGHT
ZONE
PERMIT NO.
PLAN CHECK NO.
• 11000
DEVELOPMENT NO
PLAN CHECK FFF.q Q