HomeMy WebLinkAboutX2020-2791 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application �"m
Comm'I F_ Residential City of Newport Beach - Building Division X 2v ZO- G®
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL I
� Building r Grading F—Drainage F_ Elec F Mech
j— Plum CuYdCut CuYdFill F_
Project Address (Not mailing address) r- Flood F_ Fire j— Liq r Landslide r_N/A Floor Suite No
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Description of Work 41> Fly Ili
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#Stories #Units (ifRes)�
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Valuation $
Material/Labor
New/Add SFF— Remodel SFF— Garage/New/Add F
OWNER'S NAME Last' L ijt)i First
Owner's Address
Owner's E-mail Address
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City / /1 4t —O0 ® State I r� -
Zip q=d Telephone
APPLICANT'S NAME Last
First
Applicant's Addres
Applicant's E-mail Address
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City State t7A
Zip gZ�f3 7 Telephone � 67,%U
ARCHITECT/DESIGNER'S NAME Last I First r— ,
r-I— C, Lic. No.
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
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City /51t% r [,�il'�# State I ('1i-
Zip 1 1), aTelephone F
ENGINEER'S NAME Last I
First Lic. No. 11
Engineer's Address
Engineer's E-mail Address
City I State F_
Zip F Telephoned
CONTRACTOR'S NAME/COMPANY '
Lic. No. (� Cla7�p
i� _
Contractor's Address
Contractor's E-mail Address
707 /iv�CJ`"l�i�% jc vO
city �5 t /� fGGS State C A
Zip dOl 7 Telephone 7/1 - 71j
SETBACKS REAR SETBACKS FRONT
PERMIT NO. ^ ��/� 6 WI
SETBACKS LEFT SETBACKS RIGHT _
PLAN CHECK NO. j.3,01 4 %yV Soo
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $