HomeMy WebLinkAboutX2020-2753 - Permit ApplicationPrint Form
F Comm'I
I Worksheet for Combo Building & Solar Permit Application
F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading F-Drainage KElec 5<Mech XPIum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F Flood F- Fire F_ Liq F_ Landslide FWA Floor Suite No
4o 17 CF MA J F_L Pax.
Description of Work
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# Stories # Units (if Res)[ 2
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Garage/New/Add
Valuation $ F:5per( J
Material/Labor
OWNER'S NAME Last ajAr*1Vjaj jdV6 ME4> First
Owner's Address
Owner's E-mail Address
1041 W.k5" Aura
jji 4L OAO_ ( AQ�yt1�/fN�yNlri.CoM
City C'pr7TJ , AP.S. , State Gp �
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zip �Z(o27 Telep�ione �jaj1 �101 to (;;i.� �i"
APPLICANT'S NAME Last /1nOhJ
First r-,F=
Applicant's Address
Applicant's E-mail Address
1041 W. 16 S. s`~2cw
?�++�hM��►� yyo�t in�s.anti
City C05vp, Ap!/^ State Z�
Zip g2<027 Telephone af-M
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/DESIGNER'S NAME Last CLW9on1 First FDA✓I p Lic. No.
4dKIIIIIIIIII14VIClesigner's Address
11119WAWDesigner's E-mail Address
M 2 3 Ra 5F C�
30ca711 P (j c-n+,o (t_, Call
City Co5-l-,,b, /MasA State
Zip q 2.&,7 7 Telephone
ENGINEER'S NAME Last W0Af'7
First Pll�OAJ Lic No.F
E5 I! �M
Engineer's Address
Engineer's E-mail Address
Iav F, 0 ST
6AMO� &Es) P-n0F.
, COwl
City MA State F�
Zip q ii o 1 Telephone '- r6!5q, 335. 4I o 1
CONTRACTOR'S NAME/COMPANY
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9 on
allp, No. %, I. ; tb'� ClassFg
Contractor's Address
Contractor's E-mail Address
City State
Zip Telephoned—
SETBACKS REAR SETBACKS FRONT
2
PERMIT NO. C�tX �C l✓ —� Zr 763
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
L�
PLAN CHECK FEES $ 1. "l Ll