HomeMy WebLinkAboutX2019-1573 - Permit Application�c2oi� 15�
Worksheet for Combo Building & Solar Permit Application�� e
Comm'I Residential City of Newp6rt Bgach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building ❑ Grading [7Drainage Elec (Mech ❑plum Cuvdcut Cu Yd HII
Project Address (Not mailing address)Flood F_j Fire Ll Liq ❑ Landslide '[]N/A Floor Suite No
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Description of Work Use Const Type
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#Stories #Units (if Res)n
Valuation $
New/Add SF (30 Remodel SF�� Garage/New/Add I � Material/Labor
OWNER'S NAME Last��} VN�I First NIO rk
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Owners Address
Owners E-mail Address
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APPLICANT'S NAME LastS7First
Applicant's Address Applicant's.E-mail Address
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ARCHITECT/DESIGNER'S NAME Last U, % Gr � � First[ , Lic. No. n
iArchitect/Designer's Address t� ArchitectlDesigner's:E-mail Address
City State L Zip [� Telephone
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ENGINEERS NAME LastFirst r Lie: No.
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Engineer's Address Engineers E-mail Address
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CONTRACTOR'S NAME/COMPANY e t �c Lic. No./ ��j3i Class��
Contractor's Address LContractor's E-mail Address
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City j . S„tate, Zip, Telephone ,
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SETBACKS REAR SETBACKS FRONT PERMIT NO. x/IDI� • 5�gj
S&TBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $