HomeMy WebLinkAboutPV2023-0193 - Permit ApplicationPrint Form I NOTE: PDUE AT Building
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Worksheet for Combo Building& Solar Permit Application
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FTBuilding F-GradingF-Drainage f,-,Elec F_Mech F- plum CuYdCut l CuYdFill F
Project Address (Not mailing address) 1- Flood r Fire F_ Liq j- Landslide F_N/A Floor Suite No
Description of Work
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#Storiesr # Units (if Res)F
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Valuation $
Material/Labor 3000v
New/AddSFF RemodelSFF Garage/New/AddF—
OWNER'S NAME Last th
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Owner's Address Owner's E-mail Address
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City WuC•4 je uc h State C% Zip jL(�V Telephone�—
APPLICANT'S NAME Last a First Vr "tq_
Applicant's Address Applicant's E-mail Address
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City a z�7 State C� Zip 6'i2, Q- Telephone 71 P &,Z -S4 Z2
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.F
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_ Zip F_ Telephone—
ENGINEER'S NAME Last First n Lic. No'
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Engineer's Address Engineer's E-mail Address v� /
city State Zip Telephoner
CONTRACTOR'S NAME/COMPANY c Lic. No. (ON1 Class ac)
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Contractors Address Contractor's E-mail Address
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City .0-t 0ri,Gn16z State C(k Zip I �ZqG6_ Telephone glLi- 2y2 -5 tfa
SETBACKS REAR SETBACKS FRONT PERMIT NO. cy z, (✓ j - OM )
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 07Z5
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $