HomeMy WebLinkAboutX2022-1164 - Permit ApplicationPnnt Form Worksheet for Combo Building & Solar Permit Application
Cit f N rt B h B 'Id' D'
New
F_ Comm'I F`, Residential y o
eac - ul Ing Ivaslon
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[,Building r Grading (-Drainage r: Elec Mech �, Plum
Address (Not mailing address) E Flood [ Fire r Liq
of Work
Cu Yd CutF Cu Yd Fill
[ Landslide F_N/A. Floor
3 -7 44 kwJ
New/Add SF�— Remodel SFF---' Garage/New/Add F'
Suite No
Use ConstType a,'o
# Stories # Units (if Res)�I
Valuation $
Material/Labor 1 5c/ oU 0
OWNER'S NAME
Last . �✓��� c��f ��...F� first ---- _
Owner's Address Owner's E-mail Address
- — — -
City State Zip F Telephoner '
APPLICANT'S NAME Last I First
Applicant's Address
City State
Applicant's E-mail Address
Zip F Telephoned—'.
First
ARCHITECT/DESIGNER'S NAME Last —
.. — ---------- Lic. No.
Architect/Designers Address
City State
Architect/Designers E-mail Address
Zip [_ Telephone-,
ENGINEER'S NAME Last First Lic. NoF —
Engineers Address
City State F'
CONTRACTOR'S NAME/COMPANY
r
Contractors Address
-- -
City I�(r ��, State L
SETBACKS REAR j
SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
USE ZONE
DEVELOPMENT NO
Engineers E-mail Address
Zip �- Telephoned
-
Lic-No. D 'y;)6' Classl
Contractor's E-mail Address
Zip `/ Telephone
PERMIT NO. )C -OZZ _ l 16 -1
PLAN CHECK NO. IO. O2 Z
PLAN CHECK. FEES $ L2 7 "l : 0 6