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HomeMy WebLinkAboutX2022-1299 - Permit ApplicationWorksheet for Combo Buildin Residential City of New 9 & Solar Permit A Port Beach - Building Application ��EW�DRr on NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 19 Gradin 9 [-Drainage lec F. Mech ` n lum c9yFoa� ect Address Cu Yd cut (Not mailing address) [7 Flood cu vd Fill Fire T7 Li F.- Landslide FN/A © �"�{ - a Floor Suite No J Description of Work j lC "''^- ��o�•{-G`.U�w� Use Const Type l l� # Storie New/Add SF # Units (if Res) -"" d Remodel SF --- Garage/New/Add Valuation $ OWNER'S NAME Material/Labor Last Owner's Address -0 5 �i_g First 04 Obi Owner's E-mail Address ee f __� ✓� L City State a �i— APPLICANT'S NAME Zip , Telephone Last)`� 3Sll.-2d Applicant's Address S q g [cl First Applicant's E-mail Address City State__ ARCHITECT/DESIGNER'S NAME Zip q (.._14(03 Telephone 7t( 3b --z•�b Last Arch itect/Designer's Address Firsts��� Lic. No. Architect/Designer's ner's E- - - 9 mail Address ............. City _ State ��-- -- Zip ENGINEER'S NAME Telephone Last Engineer's Address - Firsts_ Lic. No. " Engineer's E-mail Address City ............ State ................ Zip TelephoneF�--_...� - ............. CONTRACTOR'S NAME/COMPANY Contractor's Address Lic. No. .......... Class-� ontractor's E-mail Address City - State Zip Telephoner -" - SETBACKS REAR _ SETBACKS LEFT SETBACKS FRONT SETBACKS RIGHT PERMIT NO. �2G� ISE ZONE .. DEVELOPMENT NO PLAN CHECK NO. _� I�l� .lax? _5