HomeMy WebLinkAboutPV2020-096 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit A nlicatiol Wal
City of Newport Beach - Building Division 4�L i� t�'` j✓Ij Jp
j Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding F_ Grading rDrainage [Elec f—Mech F_Plum CuvdCutCu Yd Fill
Project Address (Not mailing address) F7 Flood F Fire F_ Liq r Landslide )-N/A Floor Suite No
Description of Work
Use F Const Type
# Stories # Units (if Res)7
r
-3.5
Valuation $
New/AddSF�_ — — RemodelSF�— Garage/New/AddF
-
Material/Labor
OWNER'S NAME Last ) �L eft` First
Owner's Address Owner's E-mail Address
City State F_,.m®®.m® Zip - . Telephone '-� C �p
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City � State � Zip F— Telephoned—
ARCHITECT/DESIGNER'S NAME Last First [ Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
F77
I-
City State I Zip F Telephonel—
ENGINEER'S NAME Last First F Lic. No.F_-
Engineer's Address Engineer's E-mail Address
City State F_ Zip �- Telephone—
CONTRACTOR'S NAME/COMPANY 1 ( ,1 ` n� Lic. No. lLr�. �( Class r7( e,
/ J
Conntrraactor's Address Contractor's E-mail Address
j.
L/' i /
City ( w l'L ( _ _ State [ _i 1 . Zip 5 2 � a Telephone `}C'i ScL65 5
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $