HomeMy WebLinkAboutX2022-0051 - Permit Application (3)i Prir;t Form ,� Worksheet for Combo Building & Solar Permit Application o�EWPora
t City N y of Beach - Building Division
r Comm'I � Residential � d �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding Grading
rDrainage pt6ec j�Mech j Ftum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
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Description of Work
Use I— Const Type
tr00[M vtid
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# StoriesF7, # Units (if Res)',
Valuation$
Material/Labor F/0�/
New/Add SFF —
Remodel SF 6r 3 Garage/New/Add F
OWNER'S NAME
Last 1 First l0V0
Owner's Address
Owner's E-mail Address
Pa�CI.. JACI
City %Q� v /+�
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o4t, State [-Z;— ZipTelephone 1'� q 6
APPLICANT'S NAME'
Last � First b S
Applicant's Address Applicant's E-mail Address
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City
, .Co�I
State
Q
Zip [ Telephone /l
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ARCHITECT/DESIGNER'S NAME Last First I Lic. No. _
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F — Zip Telephoner
ENGINEER'S NAME
Last First F Lic. No.1
Engineer's Address
Engineer's E-mail Address
City
State F Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY C, Lic. No. Rq1 i511 Class
Contractor's
Contractors E-mail
/Address
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City D `G
State �/ �, Zip 9� 9 Telep one 711f_L 2
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SETBACKS REAR /
SETBACKS FRONT A0 PERMIT NO. 2U2 Z^ Go S(
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. dab L - Zo2 Z
USE ZONE �Q - �Cnr^'� ,) DEVELOPMENT NO PLAN CHECK FEES $