HomeMy WebLinkAboutX2020-1300 - Permit ApplicationPrint Forrri ! Worksheet for Combo Building & Solar Permit Application
j J Comm'I TF esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Mo
uilding j' Grading ❑Drainage ❑ Elec Mech [ Plum cu Yd cut l Cu Yd Fill
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq
Description of Work
A;6A,,,�we_
New/Add SF j Remodel SF I Garage/New/Add
[I Landslide ❑N/A Floor Suite No
Use I Const Type
I yp I
# Stories # Units (if Res)',
Valuation $ �' �
Material/Labor JQ,
OWNER'S NAME Last vf� c� ! First —�
Owner's Address Owner's E-mail Address
i
City State t� Zip Telephone
APPLICANT'S NAME Last yN� _ First —_
Applicant's Address Applicant's E-mail Address
City State State 4771 Zip Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic.No.
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Architect/Designer's Address Architect/Designer's E-mail Address
I
City - ! State L ' Zip Telephone _-
ENGINEER'S NAME Last i First Lic. No. j
Engineer's Address Engineer's E-mail Address
:
City State Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. S�IoD Class��
Contractor's Address
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City I '.,,�r-� � State
SETBACKS REAR SETBACKS FRONT
Contractor's E-mail Address
Zip I Telephone C'
PERMIT NO.
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
PLAN CHECK NO.
PLAN CHECK FEES $