HomeMy WebLinkAboutX2020-0385 - Permit Application202,0,®U-
Iormt For[n Worksheet for Combo Building & Solar Permit Application F.e
l, City of Newport Beach - Building Divisions
mm'I n esidential ,,1, 0 p, Ani r Wu rW PFFF T111F AT TIME OF SUBMITTAL
P26uildin1 ❑Grading ainage ❑Flet ❑Mech ❑Plum CuvdCut cuvdFill
Project A dress (Not mailing addres) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
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ICA A WOOD A TS rTa// �lziri�
Description of Work A&DY%% Lt�fJ d ON Us/ L—/!cr Const Type W
/N �� ^ #Stories #.Units (if Res)
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Valuation$nA e0
New/Add SFodel SF Garage/New/Add Material/Labor
OWNER'S NAME Last lFirst
Owner's Address Owner's E-mail Address
City —�. ..State
Zip � Telephoned.
APPLICANT'S NAME Last–�A 1 First 10,4 y
Applicant's Address Applicant's E-mail Address -.
CityryAy 1S.tAaL? State Zip.. q`�6'% Telephoned
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ARCHITECT/DESIGNER'S NAME Last FirstNd Lic. N — 21i`J-
Architect/Designers Address Architect/Designees E -mal Address -
L z /46# 1/
Clty State Zip -� Telephone)
ENGINEER'S NAME Last---� First Lic. No.�
Engineer's Address Engineer's -E-mail Address
State ZipTelephone
City I 'i
Class
CONTRACTOR'S NAME/COMPANY Lic. No. ��� �' 3
Contractor's Address Contractor's E-mail Address
CityC ts—.J ' I State C Y Zip 1 ry J v Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
PLAN CHECK NO.
SETBACKS LEFT SETBACKS RIGHT
of AN1 rI rr.K FFFA R