HomeMy WebLinkAboutX2016-2420 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading [Drainage ❑ Elec [ IF Mech Plum Cu vd Cut Cu Yd Fill F
Project Address (Not mailing address) [ Flood Fire r7 Liq Landslide 11[IN/A Floor Suite No
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Description of Work 7i Use LConst Type C
#Stories® #Units (if Res)
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Valuation $
New/Add SF Remodel SF _ 1 Garage/New/Add aterial/Labo U
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OWNER'S NAME Last
Owner's Address
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City I A 14, � [S State �r
First
Owner's E-mail Address `
71
Zip i ( � Telephone a
APPLICANT'S NAME Last First I
Applicant's Address
City F State
Applicant's E-mail Address
Zip �� Telephone -
ARCHITECT/DESIGNER'S NAME Last , First �j Lic. No.
Architect/Designer's Address
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City P6_ � State FW71
Architect/Designer's E-mail Address
R �W_A_
Zip Telephone M. $y - �' 0 (
ENGINEER'S NAME Last _ - --� First - - Lic. No.1
Engineer's Address Engineer's E-mail Address
I
City State �- Zip Telephone��
CONTRACTOR'S NAME/COMPANY Lic. No. �" Class'
Contractor's Address
City A \ S State W7
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
Zip �� � Telephone C�1e
PERMIT NO. V 07,01 t- -
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $