HomeMy WebLinkAboutX2020-1185 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
r Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F Flood F-Fire(— Liq andslide I -N/A Floor Suite No
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Description of Work
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?(/S'o # Stories)Ij � # Units (if Res)
Valuation $
Material/Labor z�P
New/Add SF � Remodel SF 2 t; I Garage/New/Add F
OWNER'S NAME Last 5 S� 7 TAT- First
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last C-Ref)
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Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last (Zg1U First Lic. No.
Architect/Designer's Address
ArchitectlDesigner's E-mail Address
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City PA State
Zip q/(o I Telephone ,; 3-loT/-2 2N
ENGINEER'S NAME Last =-hL!d
First �Q>h �G Lic. No. C";F3-Z
Engineer's Address
Engineer's E-mail Address
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City State F�_
Zip ,7//o / Telephone Zt3 Z3/-2-791
CONTRACTOR'S NAME/COMPANY 11\1' J , t11V
/.. � (A,� Lic. No. O( 115f5 Class F_
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Contractor's Address
Contractor's E-mail Address
City State F_
Zip F_ _ Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. x,1g'�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Ro�i FW106
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ ��