HomeMy WebLinkAboutX2020-0275 - Permit ApplicationPrint Form- I v ry V I- a
Worksheet for Combo Building & Solar Permit Application R>
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❑ Comm'I ❑ Residential City of Newport Beach - Building Division X 2(►'� 2 n
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
QBuilding ❑ Grading []Drainage �yec Mech
'1-`lEls. ❑ ❑PIUm Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) ❑ Flood ❑ Fire [J Liq ❑ Landslide ❑N/A
Floor
/1 Suite No
Description of Work /IJ
r
Use Const Type
# StoriesC #Units Of Res)❑
New/Add SF Remodel SF� Valuation 3 f 7e rr�_
Garage/New/Add j f
Material/Labor r
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OWNER'S NAME Last cam`
First
Owner's Address
Owner's E-mail Address
L^
City6 , %NSlate ( e
�/ —JJJ Zip Telephoned
APPLICANT'S NAME Last 4
First
Applicant's Address
Applicant's E-mail Address
City /T:� State
Zip 7- /C� , Telephoned
ARCHITECT/DESIGNER'S NAME
Last First
Architect/Designer's Address Lic. No.
- Architect/Designer's E-mail Address
City State �Iff�---------------.----; -----
..Zip Telephone) I
ENGINEER'S NAME �� j
Last C First Lic. No. G' 0
Engineer's Address
Engineer's E-mail Address
State
City
Zip Telephoned
CONTRACTOR'S NAME/COMPANY —
Lic.. No.
Contractor's Address Class
Contractor's E-mail Address
d
city i✓d�� "J f State r. Zi
I p Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES$