HomeMy WebLinkAboutX2020-0284 - Permit ApplicationPant Form" ` Wo r meet for
❑ Comm'1 ❑ Residential Jj, NOTE:
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Combo Building & Solar Permit Application
City of Newport Beach - Building Division /�
PLAN CHECK FEES DUE AT TIME OF SUBMITTAL n Cz)
Building F] Grading
❑Drainage ❑Elec ❑Mech ❑Plum Cu Yd Cut l Cu Yd Fill
Project Address (Not mailing address) ❑ Flood ❑ Fire Liq ❑ Landslide ❑N/A Floor Suite No
Description of Work
Use Const Type s
# Storiess # Units (if Res)s
New/Add SF
Valuation $ Ivy
Remodel SFF77-7 Garage/New/Add F771 Material/Labor J>/
OWNER'S NAME
Last r First 049B404 -
Owner's Address
O ner's E- ail Address
City
State u Zip=Telephone `,7j
APPLICANT'S NAME
Last — First ''
—77
Applicant's_ Address
Applicant's E-mail Address
city —�
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State Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last First s� Lic. No.
Architect/Dgsigner'q Address
Architect/Designer's E-mail Address
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City
State Zipf(= Telephone�ilL)
ENGINEER'S NAME
Last — i _' First Lic. No.
Engineer's Address
Engineer's E-mail Address
City
J State Zipss Telephone
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Lic. No. Class
CONTRACTOR'S NAME/COMPANY
tractor's Address
Co tractor's E-mail Address
State Zip �% Telephone ///
SETBACKS FRONT PERMIT NO. 44
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SETBACKS RIGHT ry�/�P�LAN CHECK No. l j
DEVELOPMENT NO I 'r ✓�, Il P' AN CHECK FEES $
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