HomeMy WebLinkAboutX2020-2880 - Permit ApplicationPrint Form Worksheet for Goviinbc) [3uiiding 8 SWar ralrvnk Application
h t B of Newp
ort poreac-Building Division
Comm l r" Residential City
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL aF00. P
r Building r Grading
rDrainage r Elec F_ Mech (— Plum Cu Yd Cut Cu Yd Fill F
Project Addve-ss (Not mailing address) f Flood
F- Fire r` Liq (` Landslide F_N/A Floor Suite No
Description of Work
Use Const Type
# StoriesF_ _ # Units (if Res)[
/t V
Valuation $
Material/Labor
New/Add SFr-"i-_ Remodel SF (p�
Garage/New/Add
OWNER'S NAME Last C
t t�f-�
First
Owner's Address
Owner's E-mail Address
City
State F Zip Telephoners
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City I
State
Zip F_ Telephoner�s��
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
F_
Architect/Designer's E-mail Address
F_
City
State
Zip Telephone
ENGINEER'S NAME
Last
Firs Lic. No. `�—
D ?
Engineer's Address
�Engineer's E- ail Address
City
State F—
Zip Telephone
CONTRACTOR'S NAME/COMPANY tv1 Lic. No. � ClassF
Contractor's Address
Contractor's E-mail Address
City
State
Zip G'-l'b-G7g Telephoners
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. X'1,0
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. �j �• ��
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $