HomeMy WebLinkAboutX2021-3113 - Permit Application_Print Form._ i Worksheet for Combo Building & Solar Permit Application
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F_ Comm'] F Residential y u Newpo, L DeaCH - Building Division A L, I —
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading [—Drainage f7 Elec Mech F— Plum
Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood F_ Fire F- Liq r— Landslide F_N/A Floor Suite No
... . ...... . .... . - __ - - - -,S- 1. .. - F_
Description of Work
New/Add SFI,,- Remodel S Garage/New/Add
Use F—Const Type r
# Stories[— # Units (if Res)
Valuation $
Material/Labor
OWNER'S NAME Last First
----------- _ � I
Owner's Address Owner's E-mail Address
0 4/v I C 0
. . ...... ....
City I oState Zip -7 [V,�YTelephoneF? j--
APPLICANT'S NAME Last
..... .... ... _ ... .. ........
Applicant's Address Applicant's E-mail Address
. . .. .... . _., - ----- .......... ......
city State zip VV Telephone 2F7f--
ARCHITECT/DOIGNEWS NAME Last G First 1/* —IIM)V Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
A7 A/12
..... . ................ ....... .. . ..........
---_------- -- . .. . . .........
City
P 4c_ State ZiPj'1j0 1foTelephone
. . ...... ...... . ....... . ------ - --- . . ... . .1 F-
ENGINEER'S NAME Last y FirstLic. No.
. ......... . Y
Engineer's Address Engineer's E-mail Address
C/ii
.......... .
City Telephone
Zip 7136 9 Vz/,e— '-1-60-d-
__6 State C
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address
City State Zip
SETBACKS REAR
SETBACKS LEFT
USE ZONE
E-mail Address
Teleohone[
SETBACKS FRONT PERMIT NO.
SETBACKS RIGHT PLAN CHEC
DEVELOPMENT NO PLAN CHECK 4�$t W-0-