HomeMy WebLinkAboutX2019-2442 - Permit ApplicationWorksheet for Combo
i 'Residential building Solar permit
City of Newport Be Building
Building NOTE: PLAN CHECI<F Beach Division �ppilCatlOn
Gradin EES D �iEWpQ�
.. g C Drainage - UE AT TIME OF SUBMITTAL
Pro• ['Flet l Mech F
Jett Address C Plu,n
/ (Not mailing address) f Flood Cu Yd cutr��
,.till,
/ cu Yd pill j
Fire J"'".LiR �`�- Landslide I
Description of Work [`N/A Floor
rj`�----._. .Suite NOl
�j Use I Const Type
New/Add SF�`.�---- cr_
�� ---- Remodel SF#Stories
�`�"-�---, #Units (if Res)
OWNER'S NAME, Garage/New/Add Valuation$
Last Material/Labor A4 /
Owners Address ��•t%2_ -
First
SS
Owner's E- at Address
city
��
APPLICANTS State G7
NAME.' Zip rl Eo✓ .
Last / TetephoneF---
Applicant's Address /K{S51>
First /..3
E_In
(s=,_r., Applicant's
City all Address
tl,
State
%
ARCHITECT/DESIG 2ip-15/Telephone
�-`
f--'rte. Telephone
ArchitecVDesigner'�� �9z -,
s Addres Last
s First
- - - Architect/Des' Lic. No.-'�--
City -4- r- 19ner'sndress
State
ENGINEER'S zip I
NAME 7elephoneIi""-'--
Lash
Engineer's Address -ji
First
Lic. No.I�
Cit Engineer's E ma Address " "�
yl�e-
=� State"_. -
CONTRACTOR'S G/ Zip l '
NAME/COMPANY %2 �'� -� Telephoner`"`--
Contractor's Address
I c Lit
oiF class��-� -
City �` �'-r�...-iTAy ---"- ContfactorsE-mailgddre '
State zip
J -^ moi% �} �i
d .
SETBACKS REAR t1 �1`e, 7elephonel /�j
SETBACKS.LEFT SETBACKS FRONT 1 / ` } '
USE ZONE — — SETBACKS RIGHT -- - PERMIT NO.
DEVELOPMENT No -- - - PLAN CHECK N0.
`� PLAN CHECK FEES $ --- I