HomeMy WebLinkAboutX2015-2564 - Permit ApplicationX 2O 1 � Z I--(
Worksheet for Combo Builcl'':iag & Solar Permit Application
r Comm'IResidential City of Newport Be ch - Building Division
'-' \ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI
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r Suilding r Grading rDrainage rElec rMech j Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood F-, Fire r Liq r7l Landslide FN/A Floor Suite No
Description of Work
Use ConstT YPe
# Stories # Units (if Res))
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Valuation $ --- 77
Material/Labor
[7
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New/Add SF Remodel SF�
Garage/New/Add F
OWNER'S NAMErst
Last
First
TAtmc—F_
Owner's Addres,(s�,
Owner's E-mail Address
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r
City 'N %1%(, -'[ G State
' I�-u=�C.C��1ro
'; Zip ��UTelephone �`lG(_
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APPLICANT'S NAME Last �t t r 2r v�
First
Applicant's
Applicant's Address
Applicant's E-mail Address
11;07 - AMettk VOV�tk�l=t3
rid C�t2v c% P ..c c� �1
City C56wwT-6L
Ar i 1. State r .,'
—�Lic.
Zip � j(Q�'. Telephoned
ARCHITECT/DESIGNER'S NAME
Last First No.
Architect/Designer's Address
Architect/Designer's E-mail Address
I ' i
City State
Zip Telephone��l
ENGINEER'S NAME Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City _,_ _ a State F_.
Zip I Telephone,
CONTRACTOR'S NAME/COMPANY Lic. No. 4) Class
1
Contraffcttor's Address -/
Contractors E-mail Address
City dam'/ State r_ / -'
Zip ��Telephon
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $