HomeMy WebLinkAboutX2020-2038 - Permit Application (3)Print Form I Worksheet for Combo Building & Solar Permit Application o,�E" "a>a
City of Newport Beach - Building Division
Comm'I F, Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
'Building F_ Grading r'Drainage F Elec r Mech
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Project Address (Not mailing address) Flood F_ Fire F_ Liq F- Landslide FN/A Floor Suite No
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Description of Work
Use F—ConstType F_
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# Stories #Units (if Res)
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New/Add SF 't' Remodel SF Gara a/New/Add
Valuation $ 12
Material/Labor
OWNER'S NAME Last I f ARk-�N ft- d
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First r_omy- f
Owner's Address
Owner's E-mail Address
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City I�pd(1- T State CA
Zip 51Z�;, TelephoneF—
APPLICANT'S NAME Last n ^n� .7ll
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Firstd�
Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last ���.� �
First C ,t?fS7IAn/ Lic. No. 2,
/f 33 Y
Architect/Designer's Address
Architect/Designees E-mail Address
/9'0%QecA41LS•77, Su/Tf, 17-0
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City AID .Vdid.: H. State G jv-
Zip qZ(6 0 Telephone Q cqS'/ 83,E
ENGINEER'S NAME Last K/(pj }/2SJ! (
First J4 A,1 Lic. No. C 677f Z
Engineers Address
Engineer's E-mail Address
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/ 7J I dL / �, riL j)jvq -
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City tt� j�C-low . State CA
Zip I GZ6S1& Telephone dry yg6-677z-
CONTRACTOR'S NAME/COMPANY Lic. No. e "I Class F
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Contractor's Address
Contractor's E-mail Address
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City KC4vTo72_i )3,EqcAj State GA
Zip 7Z66 8 Telephone Wyq--) 7gy_ 9ssy
SETBACKS REAR SETBACKS FRONT
PERMIT NO. l/V Vll • L� v C�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. '
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $