HomeMy WebLinkAboutX2021-0275 - Permit Application0
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Worksheet for Combo Building B$O�rPo�mAIca
Pm City of Newport
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Comm'I r, Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j Elec r Mech Plum cuvdCut
Cu Yd Fill
Suite No
Grading [Drainage rN/A Floor
Building Fire r, Liq [ Landslide
Project Address (Not mailing
address) C, Flood C F
1-:3"9 Use ConstTypeF_
Description of Work ` # Stories # Units (if Res)F'; `
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GO C G �` � ` � -/L Valuation $
Material/Labor
New/AddSF_. — Remodel SF (�C__
Garage/New/Add �— -
First F
OWNER'SNAME LastR2rV_rK\" _ _ - -
Owner's E-mail Address
Owner's Address\ L7_vrCa.� • r �'
Telephone
- �Yr " TUU
State ZIP
city
_ First �V�
APPLICANT'S NAME Last �c_" ,11 n_
Applicant's E-mail Address
Applicant's Address n 1 `C �7 LV �&
Gl ``.C^- _ r�� < _ Telephone[q Ck-3 T'r
/' State ZIP � � C�
First � f Lic No. 5j'���
CHITECT/DESIGNER'S NAME Last ��� IC(CV� C-
ArchitectlDesigner's E-mai Address
Architect/Designer'sAddresseiw��1-
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State Zip i� Lla�t 3s-�d��
C�' ��®� Telephone
City demi _.. --
Lic. No.
- First (� --. _
Last
GWEER'SNAME 6�JC
Engineer's E-mail A ss
Engineer's Address - -- -
tate Zip �—'. Telephone f---'�--'r.
City - Je6E% 'Class
- Lic. No. (�'�
CONTRACTOR'S NAMEICOMPANY ��7� �c,i ��1`z-`'� v��"�S
Contractor's E-mail Address l`
Contractor's Address f, • `LJ��'\JV\�\
State FC— Zip Zlpd ¢ Telephone /�"1`1��
City (� j N fC
SETBACKS FRONT
SE;1JPS REAR —
SETBACKS RIGHT
S DEVELOPMENT NO
PERMIT NO.
PLAN CHECK N0.
PLAN CHECK FEES $ ��