HomeMy WebLinkAboutX2020-1872 - Permit ApplicationPaint Form Worksheet for Combo Building & Solar Permit Application o4�`�Po
F- Comm'I r Residential City of Newport Beach -Building Division X,40,20 - 1677-
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �a "
iBuilding [! Grading rDrainage r Elec r Mech r Plum Curd Cut Cu Yd Fill l
JP`roject Address (Not mailing address) r— Flood f__ r Liq [_ Landslide CN/A Floor Suite No
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Descri ion of Work
Use Const Type vi3
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# Stories # Units (if Res)F
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Valuation $
Material/Labor
New/Add SF�— Remodel S� g� Gara a/New/AddrA—
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OWNER'S NAME Last First 173,
Owner's/Address Owner's E-mail Address
City!x/,4;,14 � State � Zip _� Telephone
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APPLICANT'S NAME Last 1/</,'f
(/ 5 First -7e—
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Applicant's Address Applicant's E-mail Address
City�3�// -.. State r Zip �Zli jJ.l Telephone �y9.ZF 3 /.�5 3
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City 7State Zip F_ Telephone
ENGINEER'S NAMEr 853
Last � S � � _ _ ,First Q e� Lic. No. c37
Engineer's Address Engineer's E-mail Address
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City State ew Zip Telephone
CONTRACTOR'S NAME/COMPANY T/ /Dl Lic. No. V6q (7 Class
Contractor's Address Contractor's E-mail Address
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City CZ Ll V( {'I C� Iw a State I / ' Zi P � C� Telephone L i (7G
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $