HomeMy WebLinkAboutX2021-1597 - Permit Application�°City
Worksheet for Combo- Building & Solar Permit Application (Xv,
Newport Beaeh - Building Division
of
rI Comm'I r Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding, ri Grading Drainage [�'Elec n;Mech
F'Plum cu Yd cut 'Cu Yd FillJ
Pr c1E Address (Not mailing address) Flood
F -j Fire �' Liq .,F- Landslide T.-IN/A 'Floor SuiteNo
Description of Work"
Use ConitType, .
# Stories # Units (if Resf
New/ AddSF�l
RemodelSF�
r
Garage%New/Add'F___ 7_7
Valuation $
Material/Labor
(�J
OWNER'S NAME Last,First
i
gwner f 9dtlress ,
,rro ddress ;
wne7 s EA
City I __ State-�
Zip �� Telephoned
APPLICANT'S'NAME Last
T
First:
C �(z�l/LL _
Applicant's'Address
Applicant's E-mail Address
State
Zip - Telephone 7/"2d'`��! . 1
at"
` - I
ARCHITECT/DESIGNER'S NAME Last
�t
First
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �— T State
Zip F7777 Telephone
ENGINEER'S NAME LastF777777
Flrst
j Lic.No.
Engineer'sAddress
Engineer'sE-mail Address ?'l
Olty.- _ _- State —
-
ZiP �' TeleP,hone�
'CONTRACTOR'S NAME/COMPANY
Lic. No. % II class 0 j
Contractor's Address
Contractor's E-mail Address .
City State �+
ZIP
` %� Telephone W/I?Ir_AtryU
I yGG'l� r+
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES
-�$
U-1