HomeMy WebLinkAboutX2020-2255 - Permit Application115V'PpRT
I?rintForm Worksheet for Combo Building & Solar PermittA�p liel�jtion �o e�
City of Newport - Building Division � L
r Comm'I Residential "`°""
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Gradin Draina ec [ Mech Plum cued cui�
Cu Yd Fill
Building F7 Grading F—,Drainage Elg
Project Address (Not mailing address)
Flood r Fire r Liq �, Landslide rN/A Floor Suite No
Description of Work
)Work U Const Type
(9 `1 A� �1 ' # St i s # Units (if Res)
��
ENGINEER'S NAME Last FirstLV
Engineer's Address < Engineer's E -m.
City F
State F Zip
City
Ay I Lic. No.
172
I[ A d ss
Telephone C
— N vC ! -q<'f Class g
R'S NAME/COMPANY Lic. o.
,ddress Contractor's E-mail Address
13
State t ° Zip 7Xd / Telephone1y.
--
SETBACKS REAR
SETBACKS LEFT
I icF 7nMF
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
i
AytMI , .•A VVI,'
New/Add SF i 7 _, J i Remodel SIFis Garage/New/Add �—
Valuation $
Material/Lab S r ®�
OWNER'SNAME Last r�l�JX11/ [ Gf�%
�^ x
First JO$Z1ed �bb�, SLE
Owner's Address
— -- - -i
Owner's E-mail Address
State (�iCr
city
Zip v2 ._J % Telephoneq%[
APPLICANT'S NAME Last I,,L FirstL
—
_
Applicant's Address
ff
6"7 l�LGL
Applicant's E-mail Address
State
city
Zip Telephone �
v
ARCHITECT/DESIGNER'S NAME Last
—
_ First
F Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
city State �—
-
Zip�— Telephone�—
ENGINEER'S NAME Last FirstLV
Engineer's Address < Engineer's E -m.
City F
State F Zip
City
Ay I Lic. No.
172
I[ A d ss
Telephone C
— N vC ! -q<'f Class g
R'S NAME/COMPANY Lic. o.
,ddress Contractor's E-mail Address
13
State t ° Zip 7Xd / Telephone1y.
--
SETBACKS REAR
SETBACKS LEFT
I icF 7nMF
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $