HomeMy WebLinkAboutM2020-0046 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application @040
F-� Comm'I F- Residential City of Newport Beach - Building Division s&c- DogbNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F`Building F_Gradingf—Drainage F_Elec F-Mech F Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailingaddress)F_ Flood F_ Fire F- Liq F Landslide rN/A Floor Suite No
1,4-1
Description of Work
Use F Const Type F
# Stories # Units (if Res)
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Valuation $ f�
Material/Labor i C C,
9 C
New/Add SFF— Remodel SFF—Garage/New/Add �—
OWNER'S NAME Last , First
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Owner's Address Owner's E-mail Address
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City Rk_LL� C° r" C 613 State ZiP 3t7 , �3 Telephone
APPLICANT'S NAME Last �� t i' First GI t;ea
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Applicant's Address Applicant's E-mail Address
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City �b 5% 1.-x ,1 State Zip Telephone
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ARCHITECT/DESIGNER'S NAME Last First F_ Lic. No. �
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_ Zip F_ Telephone[—
ENGINEER'S NAME/
Last � ('` r` -•t First � r. 3o C: tl Lic No.5"
Engineer's Address Engineer's E-mail Address
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CityCa State CY) Zip j C. Telephone 9 t 21(, f a
CONTRACTOR'S NAME/COMPANY Lic. No. "` t Class
Contractor's Address Contractor's E-mail Address
Cit S State Zi "a
Y2� P Telephone Lt : r�3 S,`
SETBACKS REAR SETBACKS FRONT PERMIT NO. 0-0
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $