HomeMy WebLinkAboutX2020-0319 - Permit Application (2)Print Form - Worksheet for Combo Building & Solar Permit Application0-110m,
Comm'I ''Residential City of Newport Beach -.Building Division
.NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Lj Grading ODrainage QElec Mech Plum Cu Yd cut Cu Yd Fill l
Project Address (Not retailing address) [Flood rte" Fire ❑ Liq Landslide ❑N/A Floor No
�Suite
Description of Work
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Use Const Type 1
PLAN CHECK FEES $
# Stories # Units (if Res)E1
Valuation $
Material/Labor
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New/Add SF�. Remodel SF Garage/New/Add
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OWNER'S NAMELast b ,- First
Owner's Address /
Owners E-mail Address
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City State �%ZIP C.. ry -'r _ Telephone �-• - _`.
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APPLICANT'S NAME Lastd' t
L.,,siL�-t;�7.4..o First�� -
Applicant's Address Applicant's E-mail Address c
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City i..-T.� State-`,>k�. Zip s. Telephone
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ARCHITECT/DESIGNER'S NAME Last r
7 .:�1C� �Y'V-rL First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City I State ZIP Telephone
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ENGINEER'S NAME Lasti First1727 .>� 7 d�"9 I ^ j 1 Lic.c. No. No.
Engineer's Address Engineer's E-mail Address
City ,'�- State ZIP 1 ��. Telephone f't`-i-�.
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CONTRACTOR'S NAME/COMPANY Lic. No. Class
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Contractor's Address Contractor's E-mail Address
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City �— State C ZIP�J Telephoned j
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $