HomeMy WebLinkAboutX2020-0536 - Permit Application (2)1( MA). ocj;w
Pint Fgrri :, Worksheet for Combo Building & Solar Permit Application
❑ Comm'I residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building ❑ Grading ❑Drainage ❑ Elec ❑ Mech ❑ Plum Cu
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ L�L
Description of Work I
Cu Yd Fill
❑ Landslide ❑N/A Floor Suite No
_
Use Const Type 77
# Stories❑ # Units (if Res)F]
Valuation $ 70 2 �—
New/Add SF�� Remodel SF� Garage/New/Add Material/Labor
3/��
OWNER'S NAME Last
Firstl NiC.{t_
Owner's Address Owner's E-mail Address
4444 v_,Ni W6
City eenr o,13 ib rel- MP(Z- State C Zip ZCp 25 TelephoneFc _ 7(a(p- 2 8
APPLICANT'S NAME Last
Applicant's Address
33-7 2Z—
City q�;b / +s7' State
Applicant's E-mail Address
�33IvarlcdesiCvJ(2
Zip � Telephone
NAME Last I First 1 957� Lic. No.
ArchiteeMDesigner's Address
_73r UZX 9a a 9
City I ��A4- Ac/L_ State d
Architect/Designer's E-mail Address
Zip o/ylos Telephone Wi_7T /
ENGINEER'S NAME Last 11/_�V/i First i Lic. No 9.�803
Engineer's Address
a733<. A2-c/4—
city I /2d1vU State
Engineer's E-mail Address 2
Zip 92/O Telephone
CONTRACTOR'S NAME/COMPANY Njt16_s t�Lic. No. Z?Pj00 Class C7J�
Contractor's Address
City AAr A AIUA State L ""
REAR SETBACKS FRONT
LEFT SETBACKS RIGHT
DEVELOPMENT NO
Contractor's E-mail Address
Zip Telephone
PERMIT NO.
PLAN CHECK NO. � a = _ Z.0
PLAN CHECK FEES $