HomeMy WebLinkAboutX2020-2596 - Permit ApplicationPrint Form I Worksheet for
F Comm'I X Residential
NOTE:
Combo Building & Solar Permit Application
City of Newport Beach -Building Division
PLAN CHECK FEES DUE AT TIME OF SUBMITTAL +•'
Building I— Grading rDrainage F_ Elec F Mech
r Plum Cu Yd Cut F_Cu Vd Fill F_
Project Address (Not mailing address) r Flood r Fire j— Liq j- Landslide FN/A Floor Suite No
I< 24
F_
Description of Work
Use ConstType
# StoriesF # Units (if Res)T
n
Valuation S
Material/Labor y" l
New/Add SF Remodel SF Garaga/New/Add�
OWNER'S NAME Last
First
Owner's Address ^����N
Owner's E-mail Address
—
hri`C i 4 tGGjt�2i_l.czay�
City �• 1 State
Zip cl Telephone (ci4q) 3 14---& si --E,
APPLICANT'S NAME Last �(_•
First y_
Applicant's Address
Applicant's E-mail Address
City R'j�MWC�Z.3I V,275 State
Zip CV2,(t{ - Telephone (Zj+ 35-2&f�,
ARCHITECT/DESIGNER'S NAME
Last ��'`, First ��' Lic No GL717fl L7
Architect/Designees Address
Architect/Designer's E-mail Address
eA
City State F C_� ®
ZiP q Telephone j+)—Z j - 2f C,0
ENGINEER'S NAME Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City—{�1�/fJ1 State FZ;�_
Zip F60 Telephone C3t�'��c13_4io
CONTRACTOR'S NAME/COMPANY I S`4jQ,Vl9p c 1 Lic.No. r t ���L�ClassF
l `Cononttrractor's
Contractor's Address
E-mail Address
�2'I W U- SUI C-
F-3tic5Z�cr)r)c(wv�s�t�w,oko
City Kum tX m State F
Zip F Telephone q q
?TBACKS REAR
'SACKS LEFT
]NE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMITNO. "/"Zyzo -25q6
PLAN CHECK NO. ZCC.L) - 2oZzJ
PLAN CHECK FEES $