HomeMy WebLinkAboutX2020-2437 - Permit Application- Print form
I 1Norksheetfor
F_ Comm'I r Residential
NOTE:
Combo Building $ Solar Permit Application o4�EW°°�•a
City of Newport Beach - Building Division N LD
PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building r Grading rDrainage rElec (-Meth F Plum Cu vd Cut F_Cu Yd Fill l
Project Address (Not mailing address) F Flood F_ Fire F- Liq (— Landslide FN/A Floor Suite No
Description of Work
Use F—Const Type F_
# StoriesF_ # Units (if Res)r—
Valuation $
Material/Labor
New/Add 5F / Remodel SF F
Garage/New/Add �-
OWNER'S NAME Last
First
rJv , l
Owner's Address J
Owner's E-mail Address
j % C -7 ��, 4, i5(:, ,-'"YYgC Cti4 G i T L
City Z�- w1Dc r 1 i_ _.4_ Ct, State L ;-k
Zip �/ 'Z640 TelephoneF-iC, - G1
APPLICANT'S NAME Last �, i,.�.(_.� t.�
First KC.
Applicant's Address
Applicant's E-mail Address
?c:57I 1c,c-4 L
City } t ; 55 z,, i 1 , � -) C State 7f1
Zip .Z 6 `t Telephone
ARCHITECT/DESIGNER'S NAME Last
First F_
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F�_
Zip �— Telephone�—
ENGINEER'S NAME Last 'r, C) First Lic. No.r---
Engineer's Address
Engineer's E-mail Address
V
C T�>E'i-:>'1c-111S��SOGr�IU
City /�, �� I �� , State C t\
ZIP `! Z 2 C / Telephone-7 3 7 ( -7 (-7 G
CONTRACTOR'S NAME/COMPANY ` Lic No. `; 1 ?`) Class I s
Contractor's Address _
Contractor's E-mail Address
City yyr _; S ; �_ , i i/ ; r,� c: State
Zip `P Z L `i Telephone `/; i
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $