HomeMy WebLinkAboutX2020-1942 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
j Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
71�_uilding F_ Grading F-Drainage F Elec r Mech
F Plum CuYdCut CUYdFIII
Project Address (Not mailing address) f Flood
_ Fire j Liq F Landslide I_N/A Floor Suite No
F_ 7—
9,W0\ iCJ%,4L RJL
Description of Work
Use I— Const Type F_
# Stories # Units (if Res)[
Valuation $
New/Add SF7— Remodel SFF—Garage/New/Add F
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City State F_
Zip F_ Telephoner —
APPLICANT'S NAME Last
First -T,-n
Applicant's Address
Applicant's E-mail Address
a-`10 W. G't'OJL AJ�
�CT�SS
CkKgDwtr, eU/r.
City orc.J�i State t q.
Zip jqat6S Telephone C/S(- l` 1- S`14
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. F
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
City F— State �—
Zip I TelephoneF_
ENGINEER'S NAME Last
First FW Lic No.f
Engineer's Address
Engineer's E-mail Address
City State �f m
Zip �� TelephoneF
---------------------
CONTRACTOR'S NAME/ OMPANY `�� �pw �( Lic. No. t1 69 -1 — Class
i
Contrac S-ABdress
Contractor's E-mail Address
aWo w. G�vL Aj� -
-�C %.'a Q 6 Y_,t) Lon,
owtir.
F5SI-l41-Sti&�
City prc„1cae State �—
Zip qj S Telephone
0 4v LxJ 3
'BACKS REAR SETBACKS FRONT
PERMIT NO.
\CKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
IE DEVELOPMENT NO
PLAN CHECK FEES $