HomeMy WebLinkAboutX2022-1000 - Permit ApplicationWorksheet for Combo Building
,nm'I F-Vitsidential City of Newport Beac- BuilSolar
ing p v;Po� Permit Application �E" �,
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL t�
Uuilding r Grading r-Drainage e
g j- Elec r Mech r Plum cuvdCut r—_-__-
Project Address (Not mailing address f Flood Cu Yd Fill I
/GAC ) f- Fire F" Liq f` Landslide [_N/A Floor Suite No
iA �il/,g 2�vrr—_�
Description of Work I Z
v
LNG VAS' rn i M's�
l `7r/ Const Type V/
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%G121�Gy % � GAn/, G�f # Stories # Units (if Res) —
2-7
New/Add SFF--- A'`r�aip/ �tiSUG . 4, V
NSF 7r✓� SF Garage/New/Add [__._. Valuation $
Material/Labor �j ��, ac'
0 WNER'S NAME
Last
Owner's Address �--C/ First
Owner's E-mail Address
City I I
State
Zip I Telephone
APPLICANT'S NAME
- -- Last
,y
Applicant's Address First
"��O IL ^ l,,5-A Applicant's ]E-mail Address
—
city l/�7r9 lsGasu/ State f �-
Zip ��&Z Telephone
ARCHITECT/DESIGNER'S NAME /
Last;/7 AjL, First ���
Architect/Designer'sAddress `� �l ,-/-) Lic.Nc-----
5 Architect/Designer's E-ma'r Address �
City _ f
- Staffe f `�
- - ----�" Zip I Telephoner�
ENGINEER'S NAME
Last
—
Engineer's Address First FLic.
Engineer's E-mail Address
city Zip
State F--- Telephoned --
CONTRACTOR'S NAME/COMPANY _
Contractor's Address �„ Lic. No. V5lC5tc2_,Classr
4, y�� peA Contractor's E-mail Address
I t l �11���'l G�, (�-V �
City State �� (----
Zip fy�---�
5-1
y
SETBACKS REAR SETBACKS FRONT Telephone
SETC ,LE SETBACKS RIGHT � PERMIT NO. xQGZY - 10*0
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USE ONE! PLAN CHECK NO. nq _
DEVELOPMENT NO PLAN CHECK FEES $ ' J�