HomeMy WebLinkAboutX2021-2112 - Permit Application (2)Print Form.',;� Worksheet for Combo Building & Solar Permit Application
r ' Comm'I �, Residential NOTE: PiLAN HECK FES UE AT TME OF iSUBMITT "
ty of Newportsion �/�71
;Building jX Grading ;Drainage IX Elec [X,Mech [X—, Plum CuvdCutF—Cu Yd Fill F_
Address (Not mailing address) fX_I Flood IX Fire FXT Liq r, Landslide );N/A Floor Suite No
104 cr-" t 1 e4° < r– �I
Description of Work
New/Add SF
�' Remodel SFF 0 Garage/New/Add F;
i
Use Const Type
# Stories7 # Units (if Res)F'
Valuation $ FW
mLMaterial/Labor V
OWNER'S NAME Last t4L/ k __. First
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Owner's Address Owner's E-mail Address
ante i
City StateI Zip Telephone bfj 6 r �
APPLICANT'S NAME Last
Applicant's Address
City F Los AVAw� $ State �—
ARCHITECT/DESIGNER'S NAME Last
Pik
Architect/Designer's Address
City State
ENGINEER'S NAME,,,rbbV Last
Engineer's Address
City F State
First
Applicant's E-mail Address P-
a,+m/ e&_Ced e, bu
Zip Telephone &X;?
1 First l Lic. No. F_
Architect/Designer's E-mail Address
Zip F Telephone
First Lic. No.F
Engineer's E-mail Address
Zip Telephone
CONTRACTOR'SNAMEXOMPANY `PLC Vv I td � ��
Lic. l JI, Class
Contractor's Address
l z .-effs
City S AIV f''""V ,� State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
"t, i -evs iR1 G /�"
ZipM10�j Telephone q 2 �9= �f-7y°
PERMIT NO. %C W _ G
PLAN CHECK N0. lvwmpm.
PLAN CHECK FEES $ 'qA-60