HomeMy WebLinkAboutX2020-1616 - Permit Application (3)Print Form 9(2020-1(p(�Q
Worksheet for Combo Building & Solar Permit Application pF�`� 2
City of Newport Beach - Building Division
Comm'I r Residential q
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 4.,.0,.'
Building r Grading FDrainage r Elec r Mech F– Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) [_ Flood j` Fire F Liq r— Landslide -_N/A Floor Suite No
/V ! 76A-7 �k- �� L Su
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Description
Use F—ConstTypeF_
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�oofWork } I�j
io � ( Ung �Lr 7L� Way
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aK 04 K wka,
# Stories #Units (if Res)
Valuation S
Material/Labor
New/Add SFF Remodel SFF—
Garage/New/Add F
OWNER'S NAME Last �17
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First YCf
Owner's Address
Owner's E-mail Address
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City 2 FF `C1� State �' Zip Telephone / L /
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State F_
Zip F Telephoned
ARCHITECT/DESIGNER'S NAME Last QR/Ot Firstr J"/v Lic.
Architect/Designer's Address
Architect/Designer's E-mail Address
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City I N !4 r1m State I Zip 5- TelephoneF/LL 730 -.27,P9ENGINEER'S
NAME Last
First F� Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City State F_
Zip r— Telephone F_
CONTRACTOR'S NAME/COMPANY
Lic. No. �— Class F
Contractor's Address
Contractor's E-mail Address
City � State F_
Zip F_ Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT N0.
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PLAN CHECK NO. tt
PLAN CHECK FEES t,
$ t/