HomeMy WebLinkAboutX2020-0380 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
17 Comm'I T�%Residential City of Newport Beach - Building Division X IV
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI r` U
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Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide i7N/A Floor Suite No
Description of Work Use n Const Type
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2� �I Valuation a
New/Add SF 868. Remodel SF �- Garage/New/Add `tom Material/Labor
OWNER'S NAME Last C� First / /Jb
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Owner's Address Owner's E-mail Address
City IJELF - T.. Pe=f1CN -771 J State FEA,7zip Z4, TTelephone J
APPLICANT'S NAME Last�� First f
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Applicant's Address Applicant's E-mail Address f�,
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City�((,__ (�d�,7- .�.j� - StatePEZ7 Zip ��(06, Telephone g7 r� CS Y
ARCHITECT/DESIGNER'S NAME Last First 2
I- f%(g5vr trJ Lic. No. Z 33y-
Architect/Designer's Address Architect/Designer's E-mail Address
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city p�..-�j Cyc� State �I Zip 7 64 y Telephone S _- -
ENGINEER'S NAME Last --_ _--� FirstY�L Lic.No.
Engineer's Address Engineer's E-mail Address
City T --- (----__--- - State �/�.---1 Zip Zd O` Telephone / /�Zi (3 T y77
CONTRACTOR'S NAME/COMPANY Lic. N Class
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Contractor's Address Contractor's E-mail Address
City State 1_7Zip F TelephoneF_777
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $