HomeMy WebLinkAboutX2021-2500 - Permit ApplicationPrint Form Worksheet for Combo Building& Solar Permit A li,�
F_ Comm'I f— Residential City of Newport Beac- Building Division ���
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM A
rBuilding F_ Grading F -Drainage [Elec j—Mech f—PlumCu yd Cut Cu Yd Fill
Project Address (Not mailing
address) F_. Flood F- Fire F_ Liq r— Landslide FN/A Floor Suite No
I
Description of Work
Use F—Const Type F_
# Stories # Units (if Res)F_
Valuation $
Material/Labor
New/Add SFF'' Remodel SFF_ Garage/New/Add r—'
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
city _.. _.. _
State.. Zip r--_..—,., Telephone—
I
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City -
State �--I. Zip F— Telephoned--,
ARCHITECT/DESIGNER'S NAME
Last First F_ Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State F—Zip f --Telephoner'.
ENGINEER'S NAME Last
First F_' Lic. No.r
Engineer's Address
Engineer's E-mail Address
C.
-- --
State Zip F Telephone
CONTRACTOR'S NAME/COMPANY
�CO�� �� Lic. No. 74-c>s Clas i F �'
t�
Contractor's Address
Contractor's E-mail Address L 10
(e (e, t�:- /&LI� W -t:
c.cev} i E� Goh7S� a1�Nc K50.
City S (��I./�h-s
State Zip Telephone i('zOtz-6
SE- CKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $
01,