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HomeMy WebLinkAboutX2019-4060 - Permit Application (5)Print Form Worksheet for Combo Building & Solar Permit Application Comm'( ❑Citof Beachort Residential NOTE: PLAN CH CK FEESES DUE AT Divisionlding TTIIME OF SUBMITTAL A c�wAow u Cli,.a N` Building - Grading R1 rainage ❑ Elec ❑ Mech ❑ Plum Cu Yd cut Fa Cu Yd Fill -1 7 Project (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No �Address —_� �- �A � 4 Description of Work Us �� Const Type 8 8 0 L. - D D .mil' Stories 2 #Units (if Res)7 �Yi+L 6 ��7�5-� i��12-> - � �{�/Z •S .� PL - - UM—W &__�LJly. New/Add SF Z,D�8 Remodel SF Garage/New/Add /ifZ.T aluation $ Material/Labor OWNER'S NAME Last First First Owner's Address /��- ------ Owner's E-mail Address � 1 �'G�•-- - SS' c Z' -- �� c5�� ��'"_� ��af1711_S fro • C o/Vj. City /`% State Zip Telephonaw_�a. M_ �-! APPLICANT'S NAME Last First /.•l�ur�M---ram-.. -------- Applicant's Address Applicant's E-mail Address City1 - - --- J State Zip Telephon G✓� ARCHITECT/DESIGNER'S NAME - --- Last _ � ,0�/' FirstWtvw_a Lic. No. Architect/Desi ner's ddress Arch itect/Designer's E-mail Address 5 City State F J Zip �Z�14 __Telephon ����• �© ENGINEER'S NAME Last First Lic. No X /- D-- -- - ---- Engineer's Address Engineer's E-mail Address Ciry�-� State Zip Telephon�© CONTRACTOR'S NAME/COMPANY Lic. No. Class ' Contractor's Address " Contractor's E-mail Address City J State L Ji Zip Telephoned -71 SETBACKS REAR SETBACKS FRONT PERMIT NO. SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $