HomeMy WebLinkAboutX2020-2698 - Permit ApplicationPant Form Worksheet foer Combo Building & Solar Permit
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Project Address (Not mailing address) �' Flood [', Fire [I Liq , N/AF
Landslide Floor Suite No
2841 BAYSHORE DRIVE NEWPORT BEACH, CA 92663 Fate
Description of Workpe VB
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OWNER'S NAME Last
FirstlDanial and Sarah Good
Owner's Address Owner's E-mail Address
2841 BAYSHORE DRIVE NEWPORT BEACH, CA 92663 good.dan@me.com
City State Zip Telephone 949.887.8942
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APPLICANT'S NAME Last IBlackmore
Applicant's Address
2735 De Soto Ave, Costa Mesa, CA 92626
City - State �—
Last Same as applicant ! First
ARCHITECT/DESIGNER'S NAME
First Jason
Applicant's E-mail Address
abdesign@gmail. com
Zip �— Telephone 949.274.6585
Lic. Nof�,
Architect/Designer's Address Architect/Designees E-mail Address
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City
State I Zip �—I Telephone—
ENGINEER'S NAME Last First _ F� Lic. No f�'
Engineer's Address
City State Lic. No��D' Class
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CONTRACTOR'S NAME/COMPANY
Contractor's Address
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City � State
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SETBACKS LEFT SETBACKS RIGHT
Engineer's E-mail Address
-- -Zip—i Telephon-e—
Contractor's E-mail Address /
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Zip /!/( .�// Telephone 9
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PLAN CHECK NO. L- "I L- (R1 W
PLAN CHECK FEES $
USEZONE DEVELOPMENT NO