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/ Worksheet for Combo Building & Solar Permit Application m
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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OWNER'S NAME
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Owner's Address
Owner's E-mail dress
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APPLICANT'S NAME
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Applicant's Address
Applicant's E-mail Address
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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
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State �— Zip F Telephoned--
ENGINEER'S NAME
Last First! Lic No..
Engineer's Address
Engineer's E-mail Address
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City i
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State Zip i Telephone�—
CONTRACTOR'S NAME/COMPANY a rn�a I a N Lic. No. j9 Class �
Contractor's Address
Contractor's E-mail Address
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City
State Zip _ +
SETBACKS REAR S SETBACKS FRONT / PERMIT NO.
SETBACKS LEFT 31
SETBACKS RIGHT 3 Z PLAN CHECK NO.
USE ZONE -1;—:, `7
DEVELOPMENT NO PLAN CHECK FEES $