HomeMy WebLinkAboutXR2024-0344 - Permit ApplicationPrint Form Workshee4 for Combo Building & Solar Permit Application w°°vr
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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OWNER'S NAME Last 11Z�/��
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Owner's Address
Owner's - ress
City State
Zip F— Telephoned
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E/-mail Address
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ARCHITECT/DESIGNER'S NAME Last 12��
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Architect/Designer's Address
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Architect/Designers E-mail Address
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City F_ State �—
Zip-F_ Telephoned
ENGINEER'S NAME Last
First �— Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State F—
Zip Telephonel�
CONTRACTOR'S NAME/COMPANY
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Lic No. r Class
Contractor's Address
Contractor's E-mail Address
City State
Zip F_ Telephoned --'—
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 14
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. ff ZOZ4
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $