HomeMy WebLinkAboutX2020-2395 - Permit Application�rinf Form Worksheet for Combo Building & Solar Permit Application
F Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_Buildingr Grading tl5ainage rElec r—Mech Wum Cu Yd CutF— Cu Yd Fill
Project Address (Not mailing address) F_ Flood r Fire F_ Liq r Landslide rN/A Floor Suite No
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Description of Work I
Use ConstType F
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# Stories # Units (if Res)F
el
Valuation $
Material/Labor
New/AddSFF Remodel SFF Garage/New/AddF
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State F_" Zips-F— Telephoned
APPLICANT'S NAME Last x 14 o CUT /� girst V-)W
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Applicant's Address Applicant's E-mail Address
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I l t (U'`, �-� � � �IQX�I�tl� V v0 S C V C,NIkIiMq o, `l
City Lid/ O G, r,, 1 ;; State Zip TelephoneF
ARCHITECT/DESIGNER'S NAME Last First _ Lic. No.
ArchitectlD/esigner's Address .gn r' - 'Address
�! O O✓ tD
/1
777
City I --a C, t State �® ZipelephoneENGINEER'S
V VLast
NAME First F Lic. No.F
Engineer's Address Engineer's E-mail Address
City State I— Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY (- y Lic. No. 1t �/ i {�
11v �,,� 14 �' \ )i Class
Contractor's Address Contractor's E-mail Address
City F_
� <rtiU n i�� �� �.��v � State �Zip Telephoner
SETBACKS REAR SETBACKS FRONT PERMIT NO, 3 I
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. I (}
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $