HomeMy WebLinkAboutX2020-2553 - Permit Application„ aunt Form,' Worksheet for Combo Building & Solar Permit Application s���W
,.
r-! Comm'I r Residential ^LnU 0-2893 City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL i t� "JN'0
F-iBuilding ❑ Grading Drainage ❑ Elec 7 Mech n Plum cu yd cut : cued Fill
17111,
Project Address (Not mailing address) ❑Flood ❑Fire ❑ Liq [I Landslide [-;N/A Floor Suite No
Description of Work
�`
Use Const Type F—J1
_
t
e� 1s5
#Stories I #Units (if Res)7, ,
j (�erl
I``�-tom 1 tel�e�r��Tc
ver % �
- --
Valuation ! ��
Material/Labor S
New/Add SF Remodel SFF
r- I
Garag a/New/Add I-- -
OWNER'S NAME Last TZ -LA r>TtN -�> First J
Owner's Address
Owner's E-mail Address
Tb��q or -c S_e4A--txw
city
-- —N 1 �-- ------ - ----J State � Zip �I Telephoned ��
APPLICANT'S NAME Last
First ----- --!
Applicant's Address
Applicant's E-mail Address
X33 -_�ww_ D,._�
City - -� P�j-- State
Zip Telephone
ARCHITECT/DESIGNER'S NAME
First �j Lic. No
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip Telephoned
ENGINEER'S NAME Last�� 17 �%
First H Lic.
Engineer's Address
Engineer's E-mail Address
City rt �j 6i - State j
ZIP Fjob SZ) Telephone 4 L 1 75�6 V �
CONTRACTOR'S NAME/COMPANY
! �S�i2 Class
_LIPSV\0�L�� _ - - Lic. No.�
Contractor's Address
Contractor's E-mail Address
s3 __ Lw>O\j _ D
City --� ��� �
- —� 1 Tj State C 1
Zi ,Z%�=-- - _- -- - -_ - -
P � Telephone Cjl{,q (�S
SETBACKS REAR SETBACKS FRONT (� PERMIT NO. ', �✓ j
SETBACKS LEFT S SETBACKS RIGHT
PLAN CHECK NO. ` 4gjJ 400
USE ZONE G — 3 DEVELOPMENT NO
PLAN CHECK FEES $