HomeMy WebLinkAboutRev20-1360 - Permit ApplicationPrint FormV�� 4/2_0 ® �! U 0Workg eet for Combo Building & Solar Permit Application QW,
Comm'I r' Residential I City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) E Flood fire �" Liq Landslide /A Floor Suite No
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Description of Work
Uti T Use F! Const Type
# Stories; # Units (if Res)
New/Add SF�7 Valuation $ G: ,
Remodel SFS Garage/New/Add Material/Lab
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OWNER'S NAME Last ��� FJ°� >A-D.i�
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Owner's Address
Owner's E-mail Address
City State
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APPLICANT'S NAME Last I �c fvctj
ckt First � e
Applicant's Address _-
_ Applicant's E-mail Address
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city Le State - r _._
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Last First I ' _ I
A ( �_ Lic. No.
5 ° tilt. t.'9 E-mail Address
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City. State FEW_ Zip. 7066 �- Telephone ZA---!"z l _..
ENGINEER'S NAME Last First
Lic. No.r`
Engineer's Address Engineer's E-mail Address
City I - - State F_ Zip [—Telephonel
CONTRACTOR'S NAME/COMPANYr Lic. No. u
AV's IQ SI r (e-)Cf� Class l I
Contractor's Address Contractor's E-mail Address
City 1 _ 3.QO_Q� State F�EW Zip c Telephone5 a�
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ a