HomeMy WebLinkAboutX2020-0299 - Permit ApplicationU2,011-
Worksheet for Combo Building & Solar Permit A li on *yo
Comm'I E] Residential
City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME ,OF SUBMITTAL
❑Bwlding ❑Grading
❑Drainage' 17 Elec Mech El Plum Cuvd cut cu Yd Fill
Pro eCt Address Not mailin address .❑ Flood i] Fire ❑ Liq [( Landslide ❑N/A Floor
J 9 )
Suite No
Description ofWgrk
Use ConstType
# Stories #{Units (if Res)❑
New/Add SF�
Remodel SF GaiageMew/Add
Valuation'
Material/Labor
OWNER'S NAME
Last;° F.Irst `
Owners�Gdress
N� .� Owner's E-mailyAddress�, -
City.,,t�
State, Zip
Telephone ' ...
APPLICANT`S NAME
Lasf
First
- IcOf�2sj,Address-
Hpplicant's"E'-rnailAdBress
' "JJ Q
7761 la��
sr Ve�lllM'.
City
p
State
z/—` ,
Zip
�
Telephone
b,
;ARCHITECT/DESIGNER'S NAME Last �t First tt', LiaNo.
Architect/Designar's,Qddress
Archiiect/Designer's E-maiLAddress
State' Zip
Telephoned
ENGINEER'S NAME
Last First
Lic. Nd.� .
Engineer's Address,"
Engineer'§ E {Heil Address
City
State Zip'
Telephone
CONTRACTOR,'S,NAMEXOMPANY
LIC. No. /' Class '
Contractor's Address
Contractor's E-mail Address
n.1-7
Iv 'bo
1 771
'Zip
E7ry`"'
'Telephone'
-.a
SETBACKS
. REAR :
- SETBACKS FRONT , PERMIT NO. LvatL�.�
SETBACKS
LEFT
SETBACKSRIGHT PLAN CHECK N(V; 6 Z?f --1,0 1D
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES$