HomeMy WebLinkAboutx2020-2597 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach -Building Division yy�a� j
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F -Building Grading
I -Drainage F_Elec F7Mech r- Plum Cu Yd cutF Cu Yd Fill
Project Address (Not mailing address) FFlood r Fire 17 Liq r Landslide FN/A Floor Suite No
Description of Work
Use � ConsbType
A4" A&-- .- Cx447
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/�°ic S:i4e% /2 CT J ICU!/4- /��; ��
�% o-' # Stories #Units (if Res)
New/Add SFI—
Valuation $
RemodelSFI— Garage/New/Add—_ Material/Labor
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
City Icer -A- r J+-
State sZ ZiP Telephone �f �"Wo
APPLICANT'S NAME
Last �- First
Applicant's Address
Applicant's E-mail Address
City
State Zip Telephone— -
ARCHITECT/DESIGNER'S NAME Last �- First F Lic. No.
Architect(Designer's Address
Architect/Designer's E-mail Address
City
State Zip �— Telephoner
ENGINEER'S NAME
Last First Lic.
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip i Telephoner—
elephonerCONTRACTOR'S
CONTRACTOR'SNAME/COMPANY Lic. No. 17�96 3 ,Class FC /i' T
Contractor's Address
Contractor's E-mail Address
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City L���.,�s </lr
State 4�rA Zip �'2�5-? Telephoneeee1Z L/47/
SETBACKS REAR
SETBACKS FRONT PERMIT NO. Vzosi. 11ol
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. fAwt .14M
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $