HomeMy WebLinkAboutX2020-1446 - Permit Applicationop Lo\
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- Print Form Worksheet for Combo Building & Solar Permit Application nw-❑ Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
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Description of Work
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# Stories 3
#Units (if Res)®
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OWNER'S NAME Last �� First
Owner's Address Owner's E-mail Address
City L .l State �Zip (( Telephone F�
APPLICANT'S NAME °�
Last Le ( First i'S�T
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Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last '�-; First
{-cs-V' 't`._z1 T Lic. No.3T�_' V
Architect/Designer's Address Architect/Designer's E-mail Address
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City State F,- Zip Ci ',�t.� (f Telephone [t{ � Gi8"`ti�f'3
ENGINEER'S NAME Last 7ic�,� First�.e. ,Lic. NoTL )
Engineers Address Engpe I E-mail Address, -
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City �.: J�his i State (',. Zip ���'-7�Lj' Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. Class T J.
Contractor's Address Contractor's E-mail Address
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CityLUV,, (-'gyp+G State L- Zip T, V`�t� Telephonel��rld�`fl
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ ✓� "