HomeMy WebLinkAboutXR2023-1556 - Permit ApplicationPrint Form Worksheet for Combo Buildin
F_ Comm'I g &Solar Permit Application
r Residential City of Newport Be
rBuilding
ach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r Grading rDrainage (— Elec
Address
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mailing---- address) (— Flood r Fire f Lia
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vescnption of Work
New/Add SFF —
OWNER'S NAME
Owner's Address
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Remodel SFF_�
Last
City iJFw �1is
State.
APPLICANT'S NAME
Last 1--R ��
Applicant's Address T"
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ti\ \ �P � o G__ R i�
City
ARCHITECT/DESIGNER'S NAME
Last
Architect/Designer's Address
City
ENGINEER'S NAME
Last
State
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Cu Yd Fill l
Landslide d=f_ N/A Floor
Suite No
Use I Const Type �—
# Stories? # Units (if Res)r—
Garage/New/Add F-- IMaterial/Labor
Va n Fzsoo
First
Owner's E-mail Address
Zip
57 Telephone t)�L\f3 ^ z 5C,
First N t L-
Applicant's E-mail Address
Zip '> / �j`7 Telephone , (C( �)� (f 3
Lic. No. F�
—�_ Architect/Designer's E-mail Address
State F—
Zip F__
Telephone--
First
First)
Engineer's Address Lic. No.r —
Engineer's E-mail Address
City
State Zip
TelephoneF�
CONTRACTOR'S NAME/COMPANY
Lic No.
Contractor's Address Class F
Contractor's E-mail Address
City
State F_ Zip F Telephoner
SETBACKS REAR
i SETBACKS LEFT
i USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO. �CZa23• 1396
PLAN CHECK FEES $