HomeMy WebLinkAboutF2021-0118 - Permit ApplicationWbrkslfLuiFCity of ePrPiebPttminApplicatio
Newport
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Print Form
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Associated Building Permit # rl Fire Sprinkler Fir la�ih FirB Misc
1. Project Address (Not mailing address) Floor Suite No
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Tenant Name N\ P_ j�r # Units
2. Description of Work
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City
State Zip TelephoneF
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Use
Extg Sq Ft r New/Added Sq Ft Total Sq Ft
Valuation $
Architect/Designer's E-mail Address
—
# Stories
New r Add Alter r Demo
f— 5. Engineer's Name Last
Check Appropriate Box for Applicant/Notification
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F 3. Owner's Name Last
First
Owner's Address
Owner's E-mail Address
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City
State Zip TelephoneF
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F_ 4. Arch itect/Designer's Name
Last �— First [_ Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
City
State F Zip [—Telephone
f— 5. Engineer's Name Last
First Lic. No. F
Engineer's Address
Engineer's E-mail Address
City
StateZip F— Telephoner
31,
6. Contractor's Name Last e S i First Lic. No. w ----J 3`Class C,—LOC
Contractor's Address
Contractor's E-mail Address
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City ��tJ��(n `/l_ \C�
State Zip UI � G] Telephone -7J�'Ug2_- -72
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OFFICE USE ONLY
Zia" Or PER NO.
TYPE OF CONSTRUCTION
PLAN CHECK NO. dl✓�Ilr7�
OCCUPANCY- GROUP
X)MA PLAN CHECK FEE $