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HomeMy WebLinkAboutX2020-2268 - Permit Applicationi '✓ V Print Form Worksheet for Co 7 �� r I v L o a Combo Building &Solar Permit Application orE�PoR@ (� Comm I Residential City of Newport Beach - Building Division NOTE. PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 4 ❑Building Grading []Drainage [jElec ° ro ech Project Address NotPlom Cu Yd cut a vd Fm i mailing address) ❑ Flood E] Fire Cj Li q [Lands--tid-ee [N/A Floor 'Q, > Suite No i i Cw �o zT £flc^fA G ®, Description of Work New/Add SF ib' Remodel SF � Garage/New/Add OWNER'S NAME Last 3C :. o n _ . Use ConstTypel I #Stories # Units (if Res) i b�Valuation -.. Material/Labor �� Soo DO Owner's Address First) Ql. Aii j TAL A G .04 —�_ Owner's E-mail Address City N State CiA I G �W"gnj `� 140Till A0L `491y9 Zip Telephone APPLICANT'S NAME Last �aArD pJ ¢2 d-1 Applicant's Address City State I. ARCHITECT/DESIGNER'S NAME Last j First Applicant's E-mail Address ZIP s%29t-D , Telephone s-1, Architect/Designer's �I—� Deslgner's Address Lic No �—i Architect/Designer's E-mail Address City State I I Zip �' j '-------.J Telephoned ENGINEER'S NAME Last. l- -- Engineer's Address First Lic. No.l I I Engineer's E-mail Address ' Ciry State Zip r 1 � Telephone CONTRACTOR'S NAME/COMPANY CT�L9txl. . Contractor's Address LicNo. �tl a Class d i �'•Z Contractor's E-mail Address +v ��� 1 city bvt�n w G c� J r�AN ,L l 14,6 OZL11 ------------J State Zip �i156 I Telephone P SETBACKS REAR SETBACKS FRONT SETBACKS LEFT ��, PERMIT No.>i ---- � SETBACKS RIGHT USE ZONE ---- PLAN CHECK NO. if' A DEVELOPMENT NO PLAN CHECK FEES $ t