HomeMy WebLinkAboutX2020-2164 - Permit Application (2)Print Form Wor eet for Combo Building & Solar Permit Application p* WAR
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F- Comm'I F- Residential"7 City of Newport Beach - Building Division 2V2_ ' 7-1)aLI o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G aa•"
F -Building r Grading
rDrainage j(Elec FMech rK Plum cu vdcutF Cu Yd Fill
Project Address (Not mailing address) F_ Flood F- Fire r Liq r Landslide FN/A Floor Suite No
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Description of Work
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Use ConstType ll '
NO S i rVCT- rr.�L: N�Uv KI r �5,
# Storiesy6 # Units (if Res)[_
(J 9 D N� s I,I ptn� (:7j5
Valuation
New/Add SFF _c5
Remodel SF /d_j p Garaga/New/Add F 5
$ jam
Material/Labor
OWNER'S NAME
Last I � First 'H (5 (r-)
Owner's Address
Owner's E-mail Address
City r _--
State I-_ Zf Telephone
APPLICANT'S NAME
Last M6 5s 4A9�,ry First �) G
Applicant's Address
Applicant's E-mail Address
City
State f— Zip F_ Telephoned
ARCHITECT/DESIGNER'S NAME Last Lic. No. FC—71,7/
Architect/Designees Address
Architect/Designer's E-mail Address
2qO W, 7,z;:,�,W 123 t rvnn5M-A^lP6()�WIL,, cxr7 \
City / P State �� Zip \� 63 Mone�� (� � (J — 72� Z
ENGINEER'S NAME
Last First F Lic. No.1
Engineer's Address
Engineer's E-mail Address
City
State F Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY ✓� �/�2 "'Z� Lic. No.F7 14;A�e Class I `-"
Contractor's Address
Contractor's E-mail Address
City
State F_ Zip F Telephoned
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SETBACKS REAR
SETBACKS FRONT PERMIT NO. /
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. / (A V )
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $