HomeMy WebLinkAboutX2020-1404 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application 04a.
City of Newport Beach - Building Division
j�I Comm I Residential �NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[7Building Grading
[-Drainage F-1 Elec r7 Mech ❑Plum Cu Yd Cut 1 Cu Yd Fill
Project Address (Not mailing address) ❑ Flood [7, Fire ❑ Liq [J Lanlldslide ❑N/A Floor Suite No
Description of Work
Use Const Type �I
Stories C # Units (if Res)
!
Valuation $
Material/Labor -IEFX FP P-L-_O
-
New/Add SF Remodel SF �a-p —�
Garage/New/Add Ir --7
OWNER'S NAME
Last M
First
Owner's Address
Owner's E-mail Address
--
-
1 _
MPS 6c, �D Yea ✓fie.
City
�1
State Zip 1Z1� (ef� Telephone Z g
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
75
(c- �6e
City C� v _
V _ _; State 1� _I
Zip 'I Telephone Rc��j , 3 sr] (o '►t�"
ARCHITEC /DESIGNER'S NA6E
Last %
First
_- -� Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
I
City
State
i
Zip �I Telephone
ENGINEER'S NAME
Last �' l� lA
First q:zxE f's Lic. No.
Engineer's Address
Engineer's E-mail Address
City
I
_: State _- j
-----------------
Zip I Telephone
CONTRACTOR'S NAME/COMPANY �' yJ � 5 ��-�(� Lic. No. Class 1 --
Contractor's Address
Contractor's E-mail Address titi`
C.. e_y rlv41
C�rr� ;
— - - ---------...-----
City A 6 State
Zip f (� Telephone 9/`I&L 3 5-7 - & I
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $
kt�