HomeMy WebLinkAboutXR2023-0046 - Permit ApplicationPrint Form=J Worksheet for•Combo Building &Solar P rr it Application
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI A
[wilding r7 Grading F—Drainage r- Elec F_ Mech Plum Cu YdCut F_ Cu Yd Fill
Project Address (Not mailing address) [_ Flood (— Fire F_ Liq r' Landslide F_N/A Floor Suite No
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Description of Work /t,6_r ?� 0
Use L Z`(iConst Type �7--,q
i.G'/ A # Stories # Units (if Res)
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Valuation $ pd
New/Add SF e/New/Add
R F S Gara er
g �V Material/Labor /
OWNER'S NAME Last First
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Owner's Address
City State F Zip �— Telephone
APPLICANT'S NAME
Last _ First ,-._ ✓'1 ��
Applicant's Address Applicant's E-mail Address
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City I nA/_�A �C,��L� State Zip Z��2 Telephone ej
ARCHITECT/DESIGNER'S NAME Last N . Lic2
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/T/i �L--•. j _ First ��-f �i,�i7 �/ .'
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Architect/Designer's Address A Architect/Designer's E-mail Address
City Telephone
ENGINEER'S NAME Last � FirstF_ Lic. No.F___
Engineer's Address Engineer's E-mail Address
....._...- .. .
City State
CONTRACTOR'S NAME/COMPANY
Contractor's Address
Zip �— TelephoneF
—
Lic. No. cIs Class
Contractor's E-mail Address
City State F_ Zip Telephone
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. X
PLAN CHECK NO.
PLAN CHECK FEES $