HomeMy WebLinkAboutPV2020-109 - Permit ApplicationPint Form %heet for Combo Building & Solar Permit ApplicationCity of Newport Beach - Buildi isionp 0 01-'Comm'I r Reside tial V% 7 NOTE: PLAN CHECK FEES DUE AT TIME TTAL G<„oar+
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Project Address (Not mailing address) 17 Flood r re L Landslide l.- PP/ Suite No
Description of Work -'
Use ;Const Type
if StoriesT', # Units (ii
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Valuation $ �,
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OWNER'S NAME Last
Owner's Address
City _ State I W
APPLICANT'S NAME Last
First
Owner's E-mail Address
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Zip 3 Telephone goLl _r'_ qq l
First
Applicant's Address Applicant's E-mail Address
City HIgt�J?11 ct'l.. c.U� State I '.�.'-t'. Zip 1746* Telephone ?C� 5)`a
ARCHITECT/DESIGNER'S NAME Last iFirst Lic No
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip F777 Telephoned
ENGINEER'S NAME Last
Engineer's Address
City_-- - - State
- First_t_1Lic No. Z7C 7
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Engineer's E-mail Address
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Zip �z Telephone dq1
CONTRACTOR'S NAME/COMPANY v+ /tea Lic. No. t �1 Class - dt�. - - -
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on rac or s ress Contractors E-mail Address
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City I�%s, _ YI D c �>`� P _ �71c, P 447 /l
SETBACKS REAR SETBACKS FRONT PERMIT NO. Y k
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $