HomeMy WebLinkAboutX2022-1637 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application �ocEo- °aPa
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F_Comm'I F_ Residential NOTE: ty PILAN HE KOrt F ES UEBeach -ATTIME OFIsion SUBMITTAL'00'4
F Building r Grading F-Drainage F_ Elec r Mech
r Plum Cu vd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood ( Fire F_ Liq F Landslide FN/A Floor Suite No
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�/ r5 �• �)cI oC U
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Description of Work
Use F—ConstType F_
Fla:" �j/)) — / C, ,J�'( L JiL I ��;�j�� •�i
# Stories #Units (if Res)
New/Add SF ��— Remodel SF Garage/New/Add F_
Valuation �U
Material/Lab r I /
OWNER'S NAME -,
Last � �� 64 r
First
Owner's Address
Owner's E-mail Address
City �; �j State , _—
Zip _7` Telephone
APPLICANT'S NAME Last �� � S � ;
First --��--
J[i✓7 it%
Applicant's Address
Applicant's E-mail Address
/
city .L Ip� State f j
Zip /� E yI Telephone � c/� �,l ;a -o r 3 t�
ARCHITECT/DESIGNER'S NAME Last
First �� Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I— State �1 �
Zip F Telephoned
ENGINEER'S NAME Last n,,
First j/�/y L/ Lic No.
Engineer's Address
Engineer's E-mail Address
iL
-4 P/4'
City 'T;ZC,r,State C_
Zip �l„��., U Telephone _//_
CONTRACTOR'S NAME/COMPANY -
Lic No. , < < Class�/
Contractor's Address
Contractor's E-mail Address
City ,'?. State /-"-'
Zip //J (,c// Telephone /7%C// /, :;
SETBACKS REAR SETBACKS FRONT
PERMIT NO. / [,C1 L-1
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. O L 7 - -
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $