HomeMy WebLinkAboutX2020-1608 - Permit ApplicationPrint Form _ p Worksheet for Combo Building & Solar Permit Application
F Comm'IResidential City of Newport Beach - Building Division Y r/1�]I� _* 6�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI A � o
}Building F_ Grading r -Drainage Plec J_Mech [KPlum cu Yd cut F16 Cu Yd Fill
Project Address (Not mailing address) F Flood _ Fire )� Liq F Landslide I_N/A Floor Suite No
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Description of Work
Use W-9 Const Type
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1 #Stories #Units (if Res)
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valuation $ %t �; 6' i�d
Material/Labor
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New/Add SF� Remodel SF I d -7S
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Garage/New/Add a/New/Add ��
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OWNER'S NAME Last M�1zV�iJ
First
Owner's Address
Owner's E-mail Address
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City POl.Jik411 State Zip Telephone[`7—F� �, X72' 83 b
APPLICANT'S NAME Last M V t 4`t
First' to to
Applicant's Address
Applicant's E-mail Address
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City fJ „t;J1r0���---i- i,�cC State (5
Zip g7_k>E,( Telephone '2-�-,7- &7I- 53 IS je-,
ARCHITECT/!SIGN WS NAME LastF5 t16 -./'1$ First L2D^k-1 Lic. No. F_'
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City F(-;&I—/1—State ........_
Zip 2-7 Telephone I$ �Lf�epi/j2 r�
ENGINEER'S NAME Last o i4, cr
First (Q -F3 Lic. No.7—
Engineer's Address
Engiineeer''s E-mm�jail Address
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City i &A State
Zip c%L%0; Telephone 1
CONTRACTOR'S NAME/COMPANY Lic No. Y(3 65�lass
Contractor's Address
Contractor's E-mail Address
City F State r
Zip r— Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $