HomeMy WebLinkAboutX2021-1501 - Permit ApplicationWorksheets Cogfr o B rtilding Solar
Application of
Print Form
F- Comm'I j- Residential City pBuilding o _
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading F-Drainage (_ Elec F-Mech
(- Plum Cu vd Cut Cu Yd Fill
Project Address (Not mailing address) I" Flood ( Fire (- Liq f- Landslide I -N/A Floor Suite No
i
Description of Work
Use F—ConstType r—
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# StoriesF # Units (if Res)-
O� eon
Valuation $
Material/Labor
New/Add SF F— Remodel SF F— Garage/New/Add F—
OWNER'S NAME Last I`t✓E>t' First � �_
Owner's Address
Owners E-mail Address
1-4 t3i64a
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city I C. °L ! - SSttatee G¢-
l-.-
Zip Telephone---...--
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APPLICANT'S NAME Last �e First `!G
Applicant's Address
Applicant's E-mail Address
8�
Gov ef/•^-t
City -���-L, State ,GA-
Zip �2 Telephone (6
ARCHITECT/DESIGNER'S NAME Last
First F_Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
l63`71��Iv6W
A- I'Ate-alA-rr, Q 40 (.
City State
Zip 283� TelephoneF—
ENGINEER'S NAME Last � {/---�_--
First F— Lic. No. F(I c Z
Engineer's Address
Engineer's E-mail Address
,4AWIfoC�7��r—.wa@@@, C�-
City s� � State C�
ZipFZ'WO1 Telephone -7�� e, �
CONTRACTOR'S NAME/COMPANY rq
/ _ / Lic. No. ��iass
/ „I
Contractor's Address T� G � c7h-w
Contra�cctiolrsi E-Email Address
City S,( - /�/,�-i� State
Zip Telephone �( Z�30d
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO DJ L,(- (,� Z ( PLAN CHECK FEES $