HomeMy WebLinkAboutX2020-0972 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'1 Residential City of Newport Beach - Building Division
NnTF- PI AN CHECK FEES DUE AT TIME OF SUBMITTAL
4uilding F_ Grading F—Drainage it Elec r Mech r Plum CuYdCut CuvdFill F
Project Address (Not mailing address) 7 Flood r Fire F Liq r Landslide FN/A Floor Suite No
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Description doff Work
Use Const Type �
# Stories # Units (if Res)F—
I 2-b o ay en 1
Valuation $
New/Add SF �— Remodel SF F Garage/New/Add F_
Material/Labor
OWNER'S NAME Last First 1 j
Owner's Address Owner's E-mail Address
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APPLICANTS NAME Last First A) V�, t't
Applicant's Addre(s�s' Applicants E-mail
jAddress
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City �(it l (�')V�iI L State CCU Zip [er(jZy Telephone; ?U L"IID L(.S % ,
ARCHITECT/DESIGNER'S NAME Last ,� First Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
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City State F— Zip Te�lephoneF
ENGINEER'S NAME Last l�z h JXI C First 7 az% b C Ut LI g L c. No. L f O b3
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Engineer's Address Pec h
S � Engineers E-mail Address
City ItiC't,r 1t,.1 State Zp I L&C') Telephone 7 (l( k,30 (o (ti+
CONTRACTOR'S NAME/COMPANY r , �^ , S I, Lit No. I LI 6C-1 Class r,2T
Contractors Address Contractors E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO, /� (N40 1 2
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Q f p�-� ZO
USE ZONE DEVELOPMENT NO PLAN CHECK FEES S