HomeMy WebLinkAboutX2020-2971 - Permit ApplicationIPrint Form " Worksheet for Combo Building & Solar Permit Application
F- Comm'I F_ Residential City of Newport Beach - Building Division 1
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building FGradin Nraiage rElec F_Mech
tailing
F-Plumcuydcut F_ CuvdFill
Project Address ( address) F Flood Fire Liq F_Landslide �N/A Floor Suite No
LI lOg N :p1-UNt hVE. N. �
CR ci�663
Description of Work
Use ConstType
# Stories7. # Units (if Res
'1
New/Add SFF Remodel SF j�j- Garage/New/Add F
Valuation $
Material/Labor
OWNER'S NAME Last F_
First
Owner's Address
Owner's E-mail Address
City State �—
-
Zip [_ Telephoned—
APPLICANT'S NAME Last I LE
First's E
Applicant's Address
Applicant's E-mail Address
5 AEG L)NAUT- C1 2
J LEC KL-JHft9DU>( CUM
City I ALL;(D VICT() State FK —
Zip g2656 Telephone 44C(-6ci0-()Zll0
ARCHITECT/DESIGNER'S NAME Last -
First Lic. No.
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City I State
Zip F_ TelephoneF_
ENGINEER'S NAME Last
First 7— Lic.. No,
\
Engineer's Address
Engineer's E-mail Address
City State F
Zip Telephoned
CONTRACTOR'S NAME/COMPANY '� i Lic. No. � % 'ZE ZClass
Contractor's Address
CContractolr's\ E-mail Address
4
l
City ' V S t i State FE u
Zip 1 (2 _ %%- TelephoneF (j 4)
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $