HomeMy WebLinkAboutX2020-1333 - Permit Applicationk-XPZO - L3 3 �5z /J (A)
Print Form Worksheet for Combo Building & Solar Permit Application "00
Comm'I ❑ Residential City of Newport Beach - Building Division .
NOTE: PLAN CHECK FEES DUE. AT TIME OF SUBMITTAL
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Project Address (Not mailing address) ❑ Flood [] Fire p Liq ❑ Landslide CJN/A Floor Suite No
Description of Work
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#Stories #Units (if Res)1-1
Valuation $
Material/Labor
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New/Add SF
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OWNER'S NAMELast
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Owner's Address
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_ Owner's E-mail Address _
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City
State
Zip
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Telephone
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APPLICANT'S NAME
APPLICANT'S
Last ^_ _ _ First
Applicant's Address1
Applicant's Email Address
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ARCHITECT/DESIGNER'S NAME Last ��j;Z/� h _— J First -��._G � � f LIc. No.
ArchitectlDesignees Address
��— Architectl0esigner's E-mail Address
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City _ �` lr= -- --J State1 ZiP Gj a f!f! Telephone
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ENGINEER'S NAME
First �� Lic. No.�
Lasts _i
Engineer's Address
Engineer's E-mail Address
I
City
J State J Zip C i TelephoneI
-- _—
CONTRACTOR'S NAME/COMPANY Lic. No. j Class
Contractor's Address
Contractors E-mail Address
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City —
—_— f State Zip [________ Telephone—i
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. low."
USE ZONE -
DEVELOPMENT NO PLAN CHECK FEES $