HomeMy WebLinkAboutH2022-0423 - Permit Application (2)Print FormWorksheet for Combo Building& Solar Permit A lication (13
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Comm'IResidentialCity of Newport Beac-BuildingDivision2NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITT L
Building 7Grading F—Drainage KElec KMech F—Plum cu Yd Cuts Cu Yd rills
Project Address (Not mailing address) I— Flood F_ Fire F— Liq F— Landslide F_N/A Floor Suite No
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Description of Work
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Valuation $ Cc'
New/Add SF 13 7 Remodel SF 2 �f 7- Garage/New/Add C,�(ISi Material/LaborF//C
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OWNER'SNAME Last KAas First �(U_ .JcEy
Owner's Address Owner's E-mail Address
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City State C14
Zip Telephone 9 E t tj 3b' - 2L
APPLICANT'S NAME Last, 'F_-1,g(L9
Applicant's Address /
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ARCHITECT/DESIGNER'S NAME Last 0R11,
Architect/Designer's Address
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City State
First I D)Q/f D
Applicant's E-mail Address
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Zip 4� S� TelephoneI Y �{ jam'-573-/Cz.R�
First 541flD Lic. No. C27goq
Architect/Designer's E-mail Address
Zip Telephone /LF y J 7 �i /010
ENGINEER'S NAME Last J%u First j�I}C EO Lic. No. C d 37S3
Engineer's Address
Engineers E-mail Address
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City
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State
Zip
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Telephone
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CONTRACTOR'S NAME/COMPANY
Contractor's Address
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SETBACKS REAR
SETBACKSLEFT
USEZONE
State F Zip
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
Lic. No. F Classs
Contractor's E-mail Address
Telephones
PERMIT NO. t ?�
PLAN CHECK NO. i IN
PLAN CHECK FEES $