HomeMy WebLinkAboutX2020-1616 - Permit Application (4)XuZU x(4610
___Print Form Worksheet for Combo Building & Solar Permit Application
§40Comm'I [- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[—Building [- Grading [-Drainage [- Elec [- Mech
[- Plum Cu YdCut F CuvdFill
Project Address (Not mailing address) [- Flood
[- Fire [- Liq [- Landslide [-N/A Floor Suite No
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Description of Work
Use F—ConstType I
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#StoriesF_ # Units (if Res)F—
Valuation $
Material/Labor
New/Add SFF Remodel SF F—Garage/New/Add F—
OWNER'S NAME Last M la.Flz
First Jrl
Owner's Address Owner's E-mail Address
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City /V, �5wl State ZipO�
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Telephone
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State F_A Zip
Telephone d
A
ARCHITECT/DESIGNER'S NAME / /v C
Last First �vrr77�,_v Z�
l Q l0 VV Lic. No.
Architect/Designees Address
Architect/Designer's E-mail Address
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City , -A�r� -_— State FRF Zip
Telephone[7/LL ^�7n,.:�
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ENGINEER'S NAME Last
First FJ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City � State F_ Zip
F_ Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. F Class F
Contractor's Address
Contractor's E-mail Address
City �— State F Zip
Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 6
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N0.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $