HomeMy WebLinkAboutF2020-0172 - Permit Application (4)Ptint Form WO
Comm'I J Residential
for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
INDuuumg I_; urading Drainage 7,LElec AMech .ly'I Plum Cu Yd Cut I F71
J Cu Yd Fill
Project Address (Not mailing address) ❑ Flood �J Fire C Liq Landslide [-,'N/A Floor
"fr a Suite No
Description of Work
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(.�PA Use �� tC onstType izlAl
# Stories # Units (if Res),
----- ------
New/Add SF� Remodel SF - fj (6 I Garage/New/Add �— Valuation $
_ Material/Labor -- - - ----
OWNER'S NAME Last _
First
----------
Owner's Address
Owners E-mail Address
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vl��l✓�i State -�
------�--------' i'-- ZIP %� Telephone-
F"Applicant'sAddress
Last `' @ �•
_-_`I%r� _._-------— First
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Applicant's E-mail Address
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State C Zip TelephonrjrV-_1_�1! �
ARCHITECT/DESIGNER'S NAME Last (- p
-----�� (7__- -1 First PA -----4 _ � Lic. No.
ArchitecUDesigner's Address Architect/Designees E-mail Address
City 0� %��r-----� State (/f�_— Zip Z�fl Telephone
ENGINEER'S NAME Last—_— - ) First
Lic. No.�—
- --- - --- -----
Engineers Address Engineer's E-mail Address
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--- - ---- ---- ---
City --------
State I Zip—� Telephone
CONTRACTOR'S NAME/COMPANY Lic No. Class
F.
Contractor's Address Contractors E-mail Address
- _ City Zip -. ...-
Stale- -- - ' - -----------
- - Telephone
-
SETBACKS REAR SETBACKS FRONT PERM:CHECK
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S CKS LEFT SETBACKS RIGHT PLAN NO. ,QZ EDEVELOPMENT NO PLAN K FEES $
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