HomeMy WebLinkAboutX2020-1769 - Permit Application (2)X 1tKu - ITO
Pant Fo rt Worksheet for Combo Building & Solar Permit Application
F comm" F -/Residential City of Newport Beach - Building Division
NOTE PLAN CHECK MnM7E'Ani T[IotFr nr d;ulaMtT.TAI .... _ .
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Project Address (Ncft malinif aWresi
Description of Work
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New/Add SF /WdA 1 Remodel SF
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A F- ;Fire _ Liq [7 Landslide [_'N/A Floor Suite No
Use )v.y/(?ConstType
# Stories1_3 # Units (if Res)
Garage/New/Add
Valuation $ O/
A:b -; Material/Labor
OWNER'S NAME Last First T/M
Owner's Address Owner's E-mail Address
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City 1,w�aGe� �tJ State ZI GI94&5 1 Telephone �Z-363-!r(p63
APPLICANT'S NAME Last I SON
Applicant's Address
City I y� � /? ,� State F
First J itd S
Applicant's E-mail Address
Zip Gi'LGI(�3 Telephone Gyf •��j 6��
ARCHITECT/DESIGNER'S NAME Last�S--;��j�/� 3
Off+I First Lic. No.
Architect/Designees Address Architect/Designees E-mail Address
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City n Q � /? � State �QQa Zip G/ o3 TelephoneGy9�--. pG) �/
ENGINEER'S NAME Last A134t7aU4LZ First J_ o6-7 Lic. N I q yZ
Engineer's Address
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CONTRACTOR'S NAME/COMPANY
Contractor's Address
City State
SETBACKS REAR
SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
USE ZONE
DEVELOPMENT NO
Engineer's E-mail Address
Zip Telephone') {ci 2r _O y
Lic. No. F_—Class
q J�
Contractor's E-mail Address
Zip L_—._-.- Telephoned.._-....__—._..._
PERMIT NO. n67V L..0 - / l
PLAN CHECK NO. ( q
PLAN CHECK FEES $
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