HomeMy WebLinkAboutX2020-1322 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application orEW�
❑ Comm'[ Residential City of Newport Beach - Building Division r
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Projelct Address (Not mailing address) E, Flood /[ Fire ❑ Liq E] Landslide [IN/A Floor Suite No
of Work
New/Add SF Remodel SFF- Garage/New/Add
OWNER'S NAME Last
C.
Use 17, ConstType�
# StoriesC, # Units (if Res)[ —
Valuation $
Material/Labor
First I 7 C,,, „/ 0
Owner's Address / Owner's E-mail Address
•� � 0 T �i'T
city _ — State L� Zip 1 7 LAe_. Telephone
APPLICANT'S NAME Last
First )4 ( /C L.
Applicant's Address Applicant's E-mail Address
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City — N-- ----- --- ' State _ Zip l�'2 ��3 Telephone 3 z2 — 7 2 6 6
ARCHITECT/DESIGNER'S NAME Last N 0 f Ce, S First
—�N C /ALL
—- ---— Lic.No.�
Architect/Designer's Address Architect/Designer's E-mail Address
114 C �, �7 -
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City /iYL7 A ii �- l � ji��L [_ S State �- -- Zip _ /�''Z.$6�J, Telephone %fir%, �aL56.� SQo�.
ENGINEER'S NAME Last U �. First [� GC, Lic. No. i 7
Engineer's Address Engineer's E-mail Address
City State Zip Telephone
CONTRACTOR'S NAME/COMPANY
o
Contractor's Address > cc3 c• 5.^�, , �, 4
City State
�t c� /� Y Nit Y �a Y'� ✓
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
Lic. No. L� __/1, >�Class T
Contractor's E-mail Address ; w.� ciJ,��
Zip r Telephone `y p 62
9 0�7 3 -�j�.S
PERMIT NO. 7
PLAN CHECK NO.
PAF
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $