HomeMy WebLinkAboutX2020-1431 - Permit Application-Print Form
1 Worksheetfor Combo Building 8r Solar Permit Application
r, Comm1 r Residential City of Newport Beach - Building DivisiorR%����
NOTE: PLAN CHECK FEES DUE AT TIME OF SUB
[Building [ Grading
rDrainage ❑Elec [Meth Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) C Flood r Fire r Liq r Landslide rN/A Floor Suite No
21n
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Description of Work
Use I— Const Type
# Stories[— # Units (if Res)[;
Valuation $
Material/Labor
New/AddSF� Remodel SFF
Garage/New/Add F
OWNER'S NAME
Last F
First
Owner's Address
Owner's E-mail Address
City _
I
State Zip F_ Telephoner
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City
State
Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last
First l Y V v/J q�
Lic. No. v�
Architect/Designees Address
Architect(Designer's E-mail Address
City
State—
—
Zip—, Telephone
ENGINEER'S NAME
Last
First F_ Lic. No,1—
Engineer's Address
Engineer's E-mail Address
City
State—,
Zip F_ Telephoner
CONTRACTOR'S NAME/COMPANY <rAL)'5 /1
(�j
5 �N� Lic. No. 3% 7 �j/ f Class
/
Contractor's Address
Contractor's E-mail Address
1, x(5 WIL aWk
e6lAt o @ /c"_<)
City % , �N lr / k
"' �'4k_c-1_
-rte/ State
/
Zip�7�;� Telephone
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. Jiirf )
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $