HomeMy WebLinkAboutPV2021-232 - Permit Application (3)Print Form Worksheet for Combo Building & Solar Permit Application
j- Comm'I Residential City of NOTE: PLAN CHECK o FEES rt KDUE ATeach - ITIME OF lding iU�SUBMITTAL�� "
F—Building F_ Grading F-Drainage Flec F' Mech Plum Cu Yd Cut F
Cu Yd Fill F
Project Address (Not mailing address) C Flood (-" Fire F_ Liq F_ Landslide rN/A Floor
32Z L S`i1ZEET NEbo -Po�-v Bi=21cH , LA q2��(
Description of Work
IBC KOOF Mu" SOL-4 r_
Suite No
F_
Use F— Const Type
# StoriesF_ # Units (if Res)
Valuation $
New/Add SF Remodel SF Garage/New/Add F--- Material/Labor
OWNER'S NAME Last Z elnl"�y First SltvE
Owner's Address Owner's E-mail Address
-<�22 L S'CRECT
----_
City NEWPOF-T BE74iC N State �— Zip g 2�oC� l Telephone
APPLICANT'S NAME Last First �\yY)�/
Applicant's Address Applicant's E-mail Address
I ------ Z!-E....__���._....... J __.._.......... _..-------.... - - -- -- 7(1 -A >/ . \! N (A E N E W E p I . LL O -'1
_ - - -.... ---- ..... - - -- -- ---- ..-
City Lc�i' Ot�Z1 State �C,� Zip gTif Telephone qrj� Z� zi �Z(c,�
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Arch itect/Designer's E-mail Address
City State �! Zip Telephone
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
...... ....... _ . _ ..... - -- ---- ._
City State Zip Telephone
CONTRACTOR'S NAME/COMPANY i; t Nf 4U��� [ NL>L Cry 1�G`i Lic. No. `( �� �r�� Class 71�
Contractor's Address Contractor's E-mail Address
.. __ .. __ a YYl y V1N tLlao E hJ e i- G i �t
City State TA Zip -i Telephone Gi51- 2(. 4.. 17_�,'
SETBACKS REAR SETBACKS FRONT
PERMIT NO. IV W _161.
SETBACKSLEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
PLAN CHECK NO
PLAN CHECK FEES $ gr/eu, -zq