HomeMy WebLinkAboutX2019-0145 - Permit Applicationpn_ Worksheet for Combo Buildinnn Solar Permit Application sai
�/ City of Newport Beac Building Division
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Project Address (Not mailing address)lood [Fire Liq [Landslide ❑N/A Floor Suite No
jj 1 F-71 F777
Description ofWork
Use Const Type lith
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# StoriesC #Units (if Res)C
5
Material/Labor �.
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New/Add SF
� Remodel SFGarage/New/AddValuation
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OWNER'S NAME LastFirst
Owner's Address
Owners E-mail Address
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Cih' M5 State zip Telephone
APPLICANT'S NAME Last m % c-.eA?° First t J vy
Applicant's Address Applicant's E-mail Address
city p41i%11rZ State �� —i Zip .�>.J Telephone J °7%,z �7
ARCHITECT/DESIGNER'S NAME Last I First Lic:No.
Architect/Designer's.Address Architect/Designer's E-mail Address
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City State Zip Telephone
'ENGINEER'S NAME Last - j / First . 7; - ,w Lic. No. GK Y� 0
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Engineer's Address 'Engineers E-mail Address
City I ISANI4 k�, State 44 Zip ✓ 0/_ Telephone
CONTRACTOR'SNAME/COMPANY Lic.No. y -t t(7y Class
Contractor's Address Contractor's E-mail Address
City _ State �, Zip Telephoner
SETBACKS REAR. SETBACKS FRONT. PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. (w fAll—
.USE ZONE DEVELOPMENT NO PLAN. CHECK FEES $