HomeMy WebLinkAboutPV2020-001 - Permit Application-Print Form '��
Worksheet for Combo Building & Solar Permit Application no
Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES D1 IF AT TIAAF TIP a IPRAIIAi
Building DGrading ODrainage ❑Elec rlMech [71 Plum Cu YdCut
1:7 CuvdFill
Project Address (Not mailing address) ❑ Flood [7 Fire 0 Liq ❑ Landslide ❑N/A Floor Suite No
Description of Work
Use � Const Type
f '"I ,
T .. 11 n �� ! i 4 n
ti's Z -H ^^v u,v-75 it rr 104
# Stories � i # Units (if Res)
Valuation $
Material/Labor
New/Add SF� Remodel SF Garage/New/Add �
OWNER'S NAME Last r11 First LjI
Owner's Address - Owner's E-mail Address
ox, to
City ,nJ?!ni' �in I :State. Zip=� 7 /�'=�-� Telephone
APPLICANT'S. NAME Last G--" - r^
.First
Applicant's Address
Applicant's E-mail Address
l(+s
city I -Ify I ,^C;1 A State �� �. Zip '�^ �" Telephone
CJ
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
..City State Zip Telephone
ENGINEER'S NAME Lastrr----
7..rFirst Lic. No. 3
Engineer's Address Engineer's E-mail Address
City State E= ..Zip Telephoned
i
CONTRACTOR'S NAME/COMPANY c ,. i Lic. No. Class Ira C'i0
Contractor's Address Contractor's E-mail Address
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City State r�' Zip ?(;h Telephone
SETBACKS REAR SETBACKS. FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ®OOJ5 a 2$0
USE ZONE _ DEVELOPMENT NO PLAN CHECK FEES $