HomeMy WebLinkAboutX2020-1334 - Permit Application (2)i?, i4 � 5D NSD
Prirtt Form ?Worksheet for Combo Building & Solar Permit Application
141 Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
�1Building ❑Grading ❑Drainage xElec �91kech 'Plum Cuvdcutr__ J Cu Yd Fill J
Project Address (Not mailing address) ❑ Flood Fire �I Liq �I Landslide ❑N/A Floor J Suite No
am- c biz- 1 G �� I _if s l I -
Description of Work
►otENod , pwi;i o
New/Add SFE� Remodel SF_I J/ `T'� ) Garage/New/Add F
OWNER'S NAME Last L
Owner's %Address
t
City
APPLICANT'S NAME Last
First
Owner's E-mail Address
State L C- i Zip
Applicant's Address
z Ie ---
City State - (/-, Zip
ARCHITECT/DESIGNER'S NAME
Last
ArchitectlDesigner's Address
City (/ �I I State
--_ I First L ----
Applicant's E-mail
Use
# Storiesw] # Units (if Res)C
'Valuation$
Material/Labor
7! e -
)t/
First� F _ Ltc. No.
E-- ----
Architect/Designer's E-mail Address
Zip (�� ZL-6l� Telephone G1 �'_Gl/ice 7-T e'l-�
ENGINEER'S NAME Last i First Lic. Nol—
Engineer's Address
City �— - - State j
Engineers E-mail Address
i
i
Zip Telephone—I
CONTRACTOR'S NAME/COMPANY } [e -- Lic.No.[-Class��
Contractors Address
City---._ ----_.-_... - --- State F j
SETBACKS REAR
SETBACKSLEFT
SETBACKS FRONT
SETBACKS RIGHT
Contractor's E-mail Address
i
Zip [_'! Telephone
—
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO - - PLAN CHECK FEES $