HomeMy WebLinkAboutX2021-1851 - Permit ApplicationPrintFo�m Worksheet for Combo Building & Solar Pei i atior� `'" g
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City of Newport Be h --Building Division h
o 'I Residential �-
NOTE: PLAN CHECK FEES dU� T�TIME OF SUB oao.
Building F_ Grading F -Drainage [IElec F-Mech F Plum"' Xk",uCut CuvdFill
Flood Fire Li La�dsi r_N/A
Project Address address) �x� � � q � � �� Floor Suite No
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Description of Work TO ;XJ) 6 A )4 I
Use k stType F_
$A1KuS, acc.! ONS N $ATkr+r �I' �>
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Stories #Units (if Res) FT -
New/Add SF1_ ip—. Remodel SF Garage/New/Add F --------.
Valuation $ /f voD
Material/Labor JJ
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OWNER'S NAME Last pef�jy First �Gf
Owner's Address E-mail Address /
A A,�Owner's
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City _, -.... ',. State hr Zip Telephone :/ZZ_- 0%6,F
, First
APPLICANT'S NAME Last fq
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Applicant's Address Applicant's El it Address
City r---- ' State r ----J
Zip�F_ Telephone—,
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ARCHITEC77BE65IGNER— NAME Last First Lic. No.
Architect/Designer's E-mail Address
Architect/Designefs Address,,I
17M M"401V7 AA //r
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City -,.. 7W "r - StateF04-:'_Zip a Q._ Telephonel. /l666.-�7�3
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ENGINEER'S NAME Last First F ---
Lic. No.f _
Engineer's Address Engineer's E-mail Address
City State [--- Zip F—�. Telephoner—
CONTRACTOR'S NAME/COMPANY Lic. No. F— Classr—
Contractor's Address Contractor's E-mail Address
City State F Zip r------ Telephoner_
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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