HomeMy WebLinkAboutPV2020-092 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit AppliiRm Q
r Comm'I r Residential City of Newport Beach - Building Division Orr p/ e� NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL vow
[;Building r; Grading rDrainage rElec rMech r7Plum cu yd cut CuvdFill
Project Address (Not mailing address) F_ Flood r, Fire r Liq r-, rN/Ar Floor No
rSuite
R I I-
Description of Work
Use �ConstType
R Stories #Units (if Res)
7 p
� M2 rate /vt,c_n-L Yi��� � ii w hG 3 o-
/
Valuation $ •�-/
Material/Labor Ci %
New/Add SFF— Remodel SFF—i Garage/New/Add F
OWNER'S NAME Last (�� First
Owner's Address Owner's E-mail Address
City %U Uv w _ °t}Z „ State C% Zip F7_7 G -' Telephone 310-M a J
APPLICANT'S NAME Last U. First_ /l
�L
z
Applicant's Address Applicant's E-mail Address
City k 7/l v,_ -e State C//A Zip ji I �. Telephoned77�
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F777 Zip [—� Telephone
ENGINEER'S NAME Last First r ' Lic. No f
Engineer's Address Engineer's E-mail Address
City State F_ Zip I TelephoneF
CONTRACTOR'S NAME/COMPANYLic. No.F Class;
JALIA IK S_OLAW\
Contractor's Address Contractor's E-mail Address
C
1153-7
,/ 3_. l-
_�`� Imo''--�,•�L-.._._I
_ _ I
City �1 _, State (�� Zip c1 2_ ( (� Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO 721=12._ \ 01 — 0331 PLAN CHECK FEES $