HomeMy WebLinkAboutX2020-2268 - Permit Applicationi '✓ V
Print Form Worksheet for Co 7 �� r I v L o a
Combo Building &Solar Permit Application orE�PoR@
(� Comm I Residential City of Newport Beach - Building Division
NOTE. PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 4
❑Building Grading []Drainage [jElec ° ro
ech
Project Address NotPlom Cu Yd cut a vd Fm
i mailing address) ❑ Flood E] Fire Cj Li q [Lands--tid-ee [N/A Floor
'Q, > Suite No
i i Cw �o zT £flc^fA G ®,
Description of Work
New/Add SF ib' Remodel SF
�
Garage/New/Add
OWNER'S NAME
Last 3C :. o n _ .
Use ConstTypel
I
#Stories # Units (if Res)
i
b�Valuation -..
Material/Labor �� Soo DO
Owner's Address
First) Ql. Aii j
TAL A G .04 —�_ Owner's E-mail Address
City N State CiA I G �W"gnj `� 140Till A0L `491y9
Zip
Telephone
APPLICANT'S NAME
Last �aArD pJ ¢2 d-1
Applicant's Address
City State I.
ARCHITECT/DESIGNER'S NAME
Last
j First
Applicant's E-mail Address
ZIP s%29t-D , Telephone s-1,
Architect/Designer's �I—�
Deslgner's Address Lic No �—i
Architect/Designer's E-mail Address
City
State I I Zip �' j
'-------.J Telephoned
ENGINEER'S NAME
Last.
l- --
Engineer's Address First Lic. No.l I
I
Engineer's E-mail Address '
Ciry
State Zip r
1 � Telephone
CONTRACTOR'S NAME/COMPANY
CT�L9txl. .
Contractor's Address LicNo. �tl a Class d i
�'•Z
Contractor's
E-mail Address
+v ��� 1
city bvt�n w G c� J r�AN ,L l 14,6 OZL11
------------J State Zip �i156 I Telephone
P
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT ��, PERMIT No.>i
---- � SETBACKS RIGHT
USE ZONE ---- PLAN CHECK NO. if' A
DEVELOPMENT NO
PLAN CHECK FEES $ t