HomeMy WebLinkAboutXR2023-0801 - Permit Application- Print Form Worksheet for Combo Building & Solar Permit Application
mm'I rtjf{esidential lding Division
NOTE: PLLAN HECK EESty of Newport aDUE AATITIME OF SUBMITTAL IOQO) 3- NA
Gilding F_ Grading F-Drainage F_ Elec
Project Address (Not mailing a
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Description of Work
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Cu Yd Fill
Flood
r Fire r- Liq r Landslide F_N/A
Floor
Suite No
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New/Add SFF_
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Use -Z�i/iConstType j/-,A
jJ # Stories # Units (if Res)�7
Valuation $
Garage/New/Add - Material/LaboiF 2 cC
OWNER'S NAME
Last %/�_ ��2-i�yj� First
Owner's Address --'- -
City State F_
Zip �- Telel
APPLICANT'S NAME Last
First
Applicant's Address Ay
Z ^ lZ Applicant's E-mail Address
n State
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CitF16y /v Z Telephone
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ARCHITECT/DESIGNER'S NAME Zip
Last �6/VLi First ��ArL/ q�
/D/ Lic.N
Architect/Designer's Address -
//,, Architect/Designer's E-mail Address
City
State_--ZiP Telephone
ENGINEER'S NAME Last
First F� Lic No.F�
Engineer's Address Engineer's E-mail Address
City
State �® �- Telephone—
^ Zip
CONTRACTOR'S NAME/COMPANY n 1, 7
{ vg7Ye/ V Vf(�O (b yaA _3AL Lic. No. _ s����3 Class
Contractor's Address Contractor's E-mail Address
l `161 a >L� Iy
City Olin � o."PA State
I? ; � Zip q i?ai� TelephoneRSt' 27s.17J ZJ
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 2-2(J� j __ (- oc)
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO,
USE ZONE-�3 (J v�