HomeMy WebLinkAboutP2021-0251 - Permit ApplicationF?rint Form Worksheet for Combo Building x Solar Permit Application o FW faa
( Comm'I J Residential City of Newport Bea ; -Building Division r7,o�ZS
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F -'Building F_ Grading ('-'Drainage F_Elec I - 'Meeh RPlurn CuvdCut CuvdFill
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Project Address (Not mailing address) F_ Flood j- Fire F_ Liq Landslide rN/A Floor Suite No
4607 Dorchester
F_
Description of Work
Use F_ Const Type
uel line for BBQ and fuel line for fire pit
#Stories #Units (if Res)-'
Valuation $
New/Add SF Remodel SF
Garage/New/Add
Material/Labor',
OWNER'S NAME Last
First�V
Owner's Address
Owner's E-mail Address
City . - ,. State F...
- Zip F Telephoner "..
APPLICANT'S NAME Last-
First
Applicant's Address
Applicant's E-mail Address
City + State F
Zip F "Telephoner �
ARCHITECT/DESIGNER'S NAME Last
First Lie No. F__.___
F_
Architect/Designer's Address
Architect/D,-,signer's E-mail Address
City State F
Zip I Telephone—
3
ENGINEER'S NAME Last
First Lic. No. f
Engineer's Address
Engineer's E-mail .Address
City ' State
Zip Telephone� .-
CONTRACTOR'S NAME/COMPANY F_!
�—
Lic. No. Class 7-
Contractor's Address
Contractor's E-mail Address
City ",,.,.. State I
i
Zip-I"elephonel
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO _,_,
_ PLAN CHECK FEES $ R—.