HomeMy WebLinkAboutX2020-0395 - Permit Application (2)%`Zno-
Printl orm Worksheet for Combo Building & Solar Permit Application
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❑ Comm'I ❑ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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wilding ❑ Grading ❑Drainage ❑ Elec ❑ Mech ❑ Plum Cu rd Cut Cu Yd Fill
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
Description of Work
Us Ir Const Type FW
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>iC/AIN
# Sttoriries # Units (if Re )
Valuation
Material/Labor
New/Add SF Remodel SF Garage/New/Add L
OWNER'S NAME Last �� {✓_ ( First
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Owner's Address
Owner's E-mail Address
iState— ! �r Zip O Telephone
APPLICANT'S NAME Last Firstyr�`
Applicant's Address Applicant's E-mail Address
City State Zip E771 TelephoneL____1
/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's AA'd�dre�ss� Architect/Designer's E-mail Address
City �z tate ZIPTelephone'
ENGINEER'S NAME Last First Lic. No.�
Engineer's Address Engineer's E-mail Address
City C— State Zip Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. �Mass
Contractor's Address Contractor's E-mail Address
City State [TA�4, Zip 2�a�i Telephone �'7t41vo�
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SETBACKS REAR SETBACKS FRONT PERMIT NOI_
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SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. +'
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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