HomeMy WebLinkAboutX2020-0395 - Permit ApplicationMID
Print Form Worksheet for Combo Building & Solar Permit Application — ®r"q
Comm'I ❑Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
uilding ❑ Grading ❑Drainage ❑ Elec ❑ Mech ❑ Plum Cu Yd cut JJJ Cu rd Fin
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
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Description of Workkfn
{ Us Const Type
1C, Stories # Units (if Re) 1
Valuation
New/Add SF Remodel SF Garage/New/Add Material/Labor ./
OWNER'S NAME Last�7 {-(� �C
ld-f- ^ i First
Owner's Address Owner's E-mail Address
City _ State C7 Zip F7777] Telephoned
APPLICANT'S NAME Last��yam/-1 S _ First
-I�-l�—
Applicant's Address Applicant's E-mail Address
City —_ -- State ! —1 Zip TelephoneF__7
/DESIGNER'S NAME �r�
Last ( 'tom¢" First Lic. No.
Architect/Designer's Address '--�- Architect/Designer's E-mail Address
City ate F/ J Zip -C. Telephone
ENGINEER'S NAME Last j First E_ Lic. No.F
Engineer's Address Engineer's E-mail Address
City - _ State Zip Telephoned ---
CONTRACTOR'S NAME/COMPANY y(, t t �' t L} Lic. No. ' ' Oi BJass -91
Contractor's Address Contractor's E-mail Address
City _ State j Zip F Telephone t f,
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $