HomeMy WebLinkAboutX2020-0256 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I F_ Residential City of Newport Beach - Building Division s q
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL P',
Building F- Grading [—Drainage rAElec rMech OVIUm cuvdCut r cuvdFill
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Project Address (Not mailing address) r Flood f`— Fire F Liq r Landslide C_N/A Floor Suite No
0214 ac A) ,AIT
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Description of Work
Use ConstType F_
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# Stories # Units (if Res)
Valuation $
Material/Labor Fo vo
New/Add SF— Remodel SF gage/New dd
OWNER'S NAME Last L�z,
First
Owner's Address
Owner's E-mail Address
City �NN__'�' State F
Zip Telephone 7
APPLICANT'S NAME Last ✓
First A,(Z,51,4�l
Applicant's Address
2 33
Applicant's E-mail Address
�P-� i.�/ ✓d �i.(J
�o� G Irioi y-5 i 1� s } vd) o cop,
City �U7 �� State 4
Zip 6 Telephone 7,
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ARCHITECT/DESIGNER'S NAME Last �— F_
First Lic. No.
ArchitecUDesigner's Address e✓Q'M�/ ✓�P�G'�
Architect/Designer's E-mail Address G ZgD �fo
City State ��
Zip Telephone��
ENGINEER'S NAME Last
First �— Lic No.F 7—
Engineer's Address
Engineer's E-mail Address
City I State F_
Zip F TelephoneF_
CONTRACTOR'S NAME/COMPANY
Lic NoT — ClassF
Contractor's Address
Contractors E-mail Address
City i State F_
Zip F_ TelephoneF_
SETBACKS REAR SETBACKS FRONT
PERMIT NO. xxP-025(c
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 07� ,020
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
Cc. Q VIIA 1 -