HomeMy WebLinkAboutPV2023-0211 - Permit ApplicationPrint FoF71 Worksheet for Combo Building & Solar Permit Application o°�`°"m
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL j' V A0�,3 - 0�.(� G<«Ma L
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Project Address (Not mailing address) rl Flood F_ Fire r Liq F— Laflllndslide CIN/A Floor Suite No
Description of Work
Use ConstType
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Valuatio
Material La or O
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OWNER'S NAME Last 0 /KJ7�%Q� .,.-_----_, First
Owner's Addre/ssss:r���.-�//J O/wwnne�r's E-mail Addressss{%%�/�//q�
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APPLICANT'S NAME Last i�'T First _ �9
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Applicant's Address Applicant's E-mail Address
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City State Zip Telephone
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ARCHITECT/DESIGNER'S NAME Last ._ First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City State �'�! Zip F Telephone!
ENGINEER'S NAME Last �jC, �� First. Lic.No.I vg
Engineer's Address Engineer's E-mail Address
City State �� Zip �� Telephone
CONTRACTOR'S NAME/COMPANY Lic No. �', Class�l
Contractor's Address Contractor's E-mail Address
City _-, __- -_ _ State_.- -.,- Zip, Telephone,.
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $