HomeMy WebLinkAboutX2020-3005 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I 1XI Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j_Building F_ Grading F -Drainage �qlec Tech r Plum Cu YdCut �, CuvdFill _6
Project Address (Not mailing address) r Flood r Fire r Liq rLandslide KN/A Floor Suite No
Description of Work
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Use Const Type
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# Stories # Units (if Res)
Valuation $ �Q� )00
Material/Labor
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New/Add SF 21 Remodel SFF Garage/New/Add F-
OWNER'S NAME Last I PF -CK E;N (gat {+ First
Owner's Address Owner's E-mail Address
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City !2 State Zip ZfZfe25 Telephone _�
APPLICANT'S NAME Last tf First r-12,
Applicant's Address Applicant's E-mail Address
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City e. C State � Zip G Z(o6ei Telephone (E.9 Z -L 3"'.3 �Z
ARCHITECT` /'DESIGNER'S NAME LastWfo First (=.►2_ Lic. No. C 21 dZ 5'',
Architect0e�si�Ag�^ner's Address Architect/Designer's E-mail Address
City State F- Zip f- Telephone F_
ENGINEER'S NAME Last First � (n / vD Lic. No. C 3G i46
Engineer's Address Engineer's E-mail Address
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City <�� State F G� Zip Z1Telephone -11 �- - d 3 S' goo
CONTRACTOR'S NAME/COMPANY / IZ ��N�_�Jl.— c J T,,L Lic No. •SGg4/s/ ClassF
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Contractor's Address -7Contractor's E-mail Address
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City 1.1- State ( {-� Zip 9zG i� Telephone 7,1�
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SETBACKS
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $