HomeMy WebLinkAboutXR2022-2583 - Permit ApplicationPrint Form Worksheet for Combo Building& Solar Permit Application
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Comm'I Residential NOTE: City
CHECK ES DUE AT TIIMEOFDivision
SUBMITTAL
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Project Address (Not mailing address) J_ Flood
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Description of Work
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# Stories #Units (if Res)s
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Valuation
Material/Labor
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New/Add SF v Remodel SFF— Garage/New/Add I v
OWNER'S NAME Last I ACzC j-V AZ
First SC T
Owner's Address
Owner's E-mail Address
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City State ��;,
Zip [jZT (p l Tele hone a,,
APPLICANT'S NAME Last '�jZyL its;
First
Applicant's Address
Applicant's E-mail Address
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ARCHITE /DESIGNER'3ltlAME Last '-60C
First � ktn Lic. No. C _S 7 1
Architect/Designer's Address
Architect/Designer's E-mail Address
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City �Jl1L�t<, y c �n [� State
Zip Telephone �G�[ yJ `j j�.' ` C_ r `i
GINEER'S NAM Last s First Lic No.
Engineer's Address
Engineer's E-mail Address
City ®i State
Zip Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. F`I S I L Class FI�
Contractor's Address
Contractor's E-mail Address
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Zip l7t�er, Telephone (,-Z& +-t-T C,S�A
SETBACKS REAR SETBACKS FRONT
PERMIT NO. / U L(G
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO Z, /Z,— Zg 17
USE ZONE DEVELOPMENT NO
PLAN CHECK FEi�j,