HomeMy WebLinkAboutX2020-1498 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application ON
City of Newport Beach -Building Division 7,i)? 0 ' " ``� ll (�
Comm'I j- Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F -Building rGrading l -Drainage �"(ec rMech rPlum Cu Yd cutF Cu Yd Fill
Project Address (Not maeling ad�IreSS) F_ Flood r Fire F-, Liq F— Landslide F_N/A Floor Suite No
Description of
Use F—ConstType
#Stories #Units (if Res)r—
CWork
Valuat'on $
Material/Labor "f!
New/Add SFr—�- envoi SFr-- - --- Garage/New/Add y---_
OWNER'S NAME Last (y' �(� FirstI. 7,'r\6}
Owner's Address Owner's E-mail Address
t7 1 VL i \ r 1 -_
Ci State /�' 3 0
7 �}
�� �r Zip�1 l�� Telephone �/� t�� 5'�
APPLICANT'S NAME Last First G ,
Applicants Address Applicant's E-mail Address
zf L!
City L State Zip U1 �/' Telephone
AR&T D GNER'S NAME Last —� First Lic. No.
Architect/besigner's Address Architect/Designer's E-mail Address
City State Zip Telephone -- _—
ENGIN R3 NAME Last First Lic. No f -_—
Engineer's Address Engineer's E-mail Address
City State F_Zip I Telephone,
CONTRACTOR'S NAME/COMPANY y. /, , r 14 Lic. No. Class F- j
Contractor's Address Contractor's E-mail Address
is�t t 6o, 6' n-w,41- 151
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State t/Zip Telephone
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SETBACKS REAR SETBACKS FRONT T i '` r' PERMIT NO.
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SETBACKS LEFT SETBACKS RIGHT `2, 'L PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $