HomeMy WebLinkAboutPV2022-0371 - Permit ApplicationL��_, t it_r� orm _ WOrksheet for Combo Building
(� Comm'I Residential City of Newport Beac- Building i ion 77�"
on
Building Division VV NEWPoNOTE- PLAN CHECK FEES DUE AT TIME OF SUBMITTAL� V
Building j` Grading f—Drainage (` Elec
I` Mech Plum
Project Address Cu Yd Cut
(Not mailing address) [7 Flood Fire Cu Yd Fill
�• � [7 Liq (` Landslide F_N/A
-.
(, Floor Suite No
D
t._ 4
escription of Work -
s 1/
/ Use Const Type
MLKci i
# Stores
#Units (if Res)[
ew/Add SF
Remodel SF
Garage/New/Add �� Valuation $
OWNER'S NAME Material/Labor
Last ,r'- -
Owner's Address - - First
Owner's E-mail Address
city
l_ e 4c%_t State
APPLICANT'S NAME Zip /� j Telephone
Last
Applicant's Address1 u l� First
Applicant's E-mail Address
city _
_ 1
State Zip ARCHITECT/DESIGNER'S NAME Telephone
Last
Architect/Designer's Address - First
Lic. No.
Architect/Desi9 ner's E-mail Address
city
State _..
Zip
_
ENGINEER'S NAME
Last Telephone
Engineer's Address —
First
_ Lic. No.
Engineer's E-mail Address u
city
Zip
Telephone _
CONTRACTOR'S NAME/COMPANY
Contractor's Address Lic. No.�� y Class
Contractor's E-mail Address
City
State ���� �1,�v�G� _r eo�
_ _.._
.-.........
G Zip1t? Telephone
SETBACKS
REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
USE ZONE
DEVELOPMENT NO
PERMIT N0,
PLAN CHECK NO,
PLANCHECK FEES R