HomeMy WebLinkAboutS2020-0153 - Permit Application�. rint`Form _' Worksheet for Combo Building & Solar Permit Application VF Comm I fResidential City of Newport Beach - Building Division S�%/bNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building ❑Grading nDrainage
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Project Address (Not mailing
address) ❑ FloodFire ❑ Liq ❑Landslide ❑N/A Floor Suite No
Description of Work
Use 1 Const Type I J
# Stories # Units (if Res)7
New/Add SF1 Remodel SF �l Garage/New/Add F___—
Valuation $
Material/Labor
I
OWNER'S NAME Last
J First
Owner's Address
Owner's E-mail Address
City — -- - -- - - _
State _7 Zip 7 Telephoned
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
- -- --
City
— - — - - J
State l Zip I I Telephone)
ARCHITECT/DESIGNER'S NAME Last
FirstI Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
_
City
J
State l Zip Telephoned
ENGINEER'S NAME Last 1i First F_ Lic. No.F77777
Engineer's Address
Engineer's E-mail Address
City
State ZipF Telephone�j
ONTRACTOR'SNAME/COMPANY
7Uir S4 - - �eo,cLic. No.3�3C Cla
Y
C
Contractor's Address
%� Contractor's E- ail Address Z
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City --
State ��� Zip ( Telephone -_TT - 7& -
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SETBACKS
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
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