HomeMy WebLinkAboutPV2023-0584 - Permit Applicationcomm'I ! WorksheetNcoECombo Building &'SoEacrFPeBm Permit (F�&
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: PLAN CHECK
ES
UE AT
r Residential City of Newport
F- Building F_ Grading
F-Drainage rElec rMech
F- Plum cuYdCut CuYdRIF
Project Address (Not mailing address) I— Flood
r Fire F- Liq F_ Landslide FN/A Floor Suite No
Description of Work
Use F—Const Type
# Storiesr— # Units (if Res)r—
�.�. 1.�G�.+.�-. 7l(�x;-:✓l h1_. .`:.,'j. �.'YI
Valuation $
Material/Labor C, 1I6V
New/Add SFr— Remodel SFF—Garage/New/Add F_
OWNER'S NAME
Last �i.. +�.� ���
First I �ti�._ �-���, �
Owner's Address
Owner's E-mail Address
City
State
Zip F ----- TelephoneAPPLICANT'S
NAME
Last Q <:j, t i-
First -�
Applicant's Address
Applicant's E-mail Address
5 51 ._ `w-, f Y'-< ( .!.
C
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City tic>(i;�r
State (.C\
Zip Telephone P,
ARCHITECT/DESIGNER'S NAME Last First Lic. r—
No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �
State F—
ZipF Telephoned
ENGINEER'S NAME
Last
First 7 Lic. No.r—
Engineer's Address
Engineer's E-mail Address
City
State F
Zip �— Telephone[ —
CONTRACTOR'S NAME/COMPANY Lic. No. G]o5j G Class t
(,lci \t M'h': .� 4)G ¢'t"I ti.�:./> �r7•,�in i.ftfi�lT7-,
Con�t`ractor's Address
Contractor's E-mail Address
City
State F_
Zip F— TelephoneF_
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $