HomeMy WebLinkAboutX2020-0428 - Permit ApplicationPrint Form W for Combo Building & Solar Permit . �E tea, +� g 'application o� e
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r� TE: PLAN CHECK FEES DUE AT TIMF nF Si ianniTTni 0A0- ( ld'� U �
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Project Address ( of mailing address) ❑ Flood ❑ Fire F Liq ❑ Landslide ❑N/A Floor Suite No
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Description of Work
Use ConstType
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# Stories ' Units (if Res) I
Valuation $
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OWNER'S NAME Last
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First
Owner's Address
Owner's E-mail Address
City�
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Zip TelephoneFj
APPLICANT'S NAME Last
First
Applicant's dddress
Applicant's E-mail Address
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City I State!I
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ARCHITECT/DESIGNER'S NAME r —
Last - it•t ,��First C, Lic. No.-
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Architect/Designer's Address
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Architect/Designees E-mail Address
City State
zip Zip F Telephone—:
ENGINEER'S NAME Last Z r*14
' First . Lic. No. _
Engineer's Address
Engineer's E-mail Address
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zip Telephone
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CONTRACTOR'S NAME/COMPANY „ Lic. No. 5 (fit lass55
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Contractors Address
Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.� Lp . ` Z
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. O•
USE ZONE _ DEVELOPMENT^1O
PLAN CHECK FEES $
Print Form
Worksheet for Combo Building & Solar Permit Application
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NOTE: PILAN HECK FEESty of Newport DUE AT TIME OFng SUBMITTAL�a0ab -byag
Building r Grading j—Drainage j—Elec rMech Plum Cu vd Cut F Cu Yd Fill
Project Address (Not mailing address) F_ Flood r Fire F_ Liq r Landslide (—N/A Floor Suite No
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Description of Work
Use [_ ConstType F
# Stories #Units (if Res)[
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Valuation $
New/Add SF F_Remodel SF Garage/New/Addy—
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Material/Labor
OWNER'S NAME Last S`✓h / / First
Owner's Address Owner's E-mail Address
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City f i2 - tia -� State �` Zip l' Telephone L 2_
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APPLICANT'S NAME Last ��ti{�' (<�Iz.tr7/ First
Applicant's Address Applicant's E-mail
Address
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ARCHITECT/DESIGNER'S NAME Last ZCp � First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City Li,�6 6,,Ju `/ 11 1L_ -s State Zip , & S 3 Telephone
ENGINEER'S NAME Last First Lic. No.1
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Engineer's Address Engineer's E-mail Address
City I State I Zip F- TelephoneF_
CONTRACTOR'S NAME/COMPANY Gxl Lic. No. �� 3tJ5�. Class
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Contractor's Address Contractor's E-mail Address
City lei / JAI% ju7 Gfj State `Z Zip % Z C' Telephone C)�/ / L[� �S u
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $