HomeMy WebLinkAboutXR2023-1578 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application SO
r Comm] r Residential City of Newportsion
NOTE: PLAN HECK FEES DUE AT Teach - dIME OF ing (SUBMITTAL �
r-Building r Grading r-Drainage r Elec r Mech r Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not ma'ling address) f Flood r- Fire r- Liq r- Landslide F_N/A Floor Suite No
Description of Work
Use F_ Const Type I
# Stories[— # Units (if Res)
_
Valuation $
0,000
New/Add SF� Remodel SF Garage/New/Add F_Material/Lahor
OWNER'S NAME Last 9 First
Owner's Address Owner's E-mail Address
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City l�n� ,jam -,Lh State G /� Zip CP Z6 Sl1 Telephone 9Tz!<j- �/p. z - f 71—�-
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APPLICANT'S NAME Last �� fs,„,/Y First
Applicant's Address Applicant's E-mail Address
City n h State li14 Zip �2 �� Telephone FYy-9i z-5 7s�
ARCHITECT/DESIGNER'S NAME Last First Lic. No. I
ArchitecUDesigner's Address Architect/Designer's E-mail Address
City State F_ Zip F_ Telephoned
ENGINEER'S NAME Last tie vi First M t'q j1Yld Lic. No. tyol i
J7
Engineer's Address Engineer's E-mail Address
City State F_ Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY r�r � n 2c9 Lic No. e 7 k76K Class
Contractors Address Contractor's E-mail Address
// �/L 20 Yd ✓�
City �6 ✓7(t State G Zip GZ7� �� Telephone p yr- fez- s7 r
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. In Yi - 1011 ti
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $