HomeMy WebLinkAboutPV2020-031 - Permit Applicationp���• DSI
Worksheet for Combo Building & Solar Permit Application
Comm'I j Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK. FEES DUE AT TIME OF SUBMITTAL
[-Building l Grading F --Drainage F- Elec Plum jr--Meeh
:. Cu Yd Cuts GrYd Fill
Project Address (Not mailing address) i Flood r Fire Liq r Landslide F_N/A Floor Suite No
Description of Work / I
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Use r- Const Type
(% U 5w5 -+c -L LA--/ jI>0Mf i S -- # Stories # Units (if Res)F
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New/Add SFS Remodel SF'Garage/New/Add Valuation
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Material/Labor
OWNER'S NAME Last I
: t Hc�.l-r, f 8 First � � � y-)
..Owner's Address
Q(3[{ Owner's E-mail Address
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City i State I CA Zip �A_t- 7tj ,Telephone C`
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APPLICANT'S NAME
,Last!i ?/Cil �, S First 1
Applicant's Address
'z- co r r Applicant's E-mailAddress
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City;,i--%i/s rte.:. State If`' Zip1 `1�7Q(LI Telephonet�. k? 4i-tL.tZ70
ARCHITECT/DESIGNER'S NAME i
Last
First! Lia No. �—
Architect/Designer's Address Architect(Designer's E-mail Address
f
i
City i State l Zip-- Telephonel
ENGINEER'S NAME ----___
Last
First I Lic. No.s--
Engineer's Address
Engineer's E-mail Address
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City F_
State Zip ; Telephonel
CONTRACTOR'S NAME/COMPANY --
1/ r Jv L+ SojLtl L'C. No. , 0173 is Class C ( S
Contractor`sAddress
Contractor's E-mail Address
City ! I-) State Zip f G2�r) �? Telephonel
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. %1
SETBACKS LEFT SETBACKS RIGHT 1;
r , '-
PLAN CHECK NO.
USE ZONE _ DEVELOPMENT No L
- PLAN CHECK FEES a
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