HomeMy WebLinkAboutX2020-0545 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
�,Biiilding r- Grading r!Drainage rElec r,Mech
F-PlumcuvdCut F Cu Yd Fill
Project Address (Not mailing address) r Flood
r Fire r Liq r Landslide rN/A Floor Suite No
2.12 I C C)r-�t it1N- tz
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Description of Work I ° 90 i it l
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Use ConstT e I
Type F
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#Stories # Units (if Res)
�Ilff MOO
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itlrG_on_ �x�(n 2 (�GICI�Iiw��1_
Valuation $
Material/Labor
New/AddSFF Remodel SFF — Garage/New/Add
OWNER'S NAME Last n (- I i� First C/ 61 q ( M c/ � I M J
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Owner's Address
Owner's E-mail Address
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Gen�;i�nm�4�m��nl��-mcnt
City I l.. Cl V. V I Y5 (f /I 61n.. State F
ZIP Fj ,LW(.'.. Telephone�..�1 11-
APPLICANT'S NAME Last Gh n C✓ n c,
First C OW
Applicant's Address
Applicant's E-mail Address
30 S GO(;In_c twat-c.)cihr!Gnt,elprornoc
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City Gq n r �n Li I State V/ \ Zip
'17270t Telephone �..1 )�) 5-/) ..5-1✓�
ARCHITECT/DESIGNER'S NAME Last r First Lic. No.
Architect/Designer's Address
ArchitecUDesigner's E-mail ddress
City State F Zip F Telephoned '..
ENGINEER'S NAME Last �—
First F Lic No.
Engineer's Address
Engineer's E-mail Address
City � ' State Zip
�— Telephone F—
CONTRACTOR'S NAME/COMPANY j7 �Cj C� f-� pI�
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ij r 1 Lic. No. ��G 51 Z Class
Contractor's Address
Contracttor's E-mail Address
33�I 5. GUsin crm if
Gc/ ric-7nc,bFromo�i�n� uG
City �' I rq.... A -n State —. Zip
G� � 1 CI Telephone t 7. It 5 -f
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. e
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $