HomeMy WebLinkAboutX2016-4131 - Permit Application2( o, P,
Worksheet for Combo Building & Solar Permit Application
(— Comm'[ Residential sion
NOTE: PLAN CHECK ty of o FEES UEATTIMEOFrt Beach - Building iSUBMITTAL
Building F- Grading
(—Drainage F_ Elec F—Mech r Plum Cu Yd cut Cu Yd Fill
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Project Address (Not mailing address) F- Flood F— Fire F7 Liq F- Landslide rN/A Floor Suite No
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Description of Work
Use F Const Type
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# Stories #Units (if Res)
Valuation $
Material/Labor
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New/Add SF ✓ (7Remodel SF �qo Garage/New/Add
OWNER'S NAME
Last First
Owners Address
Owner's E-mail Address
City
StatezipZip Telephoned —
APPLICANT'S NAME
Last First 611 W.Oe�
Applicant's Address
Applicant's E-mail Address_Q
City
State F_ Zip F Telephone
ARCHITECT/DESIGNER'S NAME Last First F �—
Lic. No.
ArchitectIDesigners Address
Architect/Designees E-mail Address
city
State Zip Telephone
ENGINEER'S NAME
Last (///A First Li N
_
,fin
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Engineer's Address
Engineers -ma Address
b }r
WM
City
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State zip Telephone �S�b
CONTRACTOR'S NAME/COMPANY Lic. No. �J� Class
I V
Contractors Address
Contractor'; E-mail Address
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v �6655
City j (� —
-- State CA ... Zip F( 7�- Telephone ! �Zz��� ZU
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SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $