HomeMy WebLinkAboutF2020-0210 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
Comm'( Fi,Jfesidential NOTE: PLAN CHECK FEES DUE AT TIME
OF SUBMITTAL'�"
IF
�-,Building j_ Grading F-Drainage r Elec
C— Mech
Project Address (Not mailing address-) f._ Flood
Descri
of Work
New/Add SF -
OWNER'S NAME
Owner's Address
F Plum CuYdCut I CuYdFil
e
LandslidFloor Suite No
r� Fire j— Liq (� —
i
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Remodel SF i_W o Garage/New/Add
7,4,0Nxz1e--C JF
Last
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Owner's E-mail Address
I Use Const Type C
# Stories # Units (if Res)[
Valuation $
Material/Labor O
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r Telephone � t�ji{307 5' Sl
CityState I ('/t, Zip G/%
APPLICANT'S NAME Last �I2� 1 First
Applicant's E-mail Address
Applicant's Address -
Zip -� -'' ' Telephone `q q( 7 7ql
Cityj� L State P f �� > j
ARCHITECT/DESIGNER'S NAME Last !3
First Lic. No.
Architect/Designer's E-mail Address
Architect/Designer's Address
/ / State I
(' , Zip Telephone � r J / `
City /--Z,-,,
��._ First �.-tr,E' Lic.No.�
ENGINEER'S NAME LastFOTHtOlt
Engineer's E-mail Address
Engineer's Address
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State �� Zip `53 Telephone e
CONTRACTOR'S NAME/COMPANY
Contractor's Address
' City tit'd�U✓
Lic. No. -�y Class
Contractor's E-mail Address
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CF1 ier v+ cziii ptLta `�
Telephone
State (� ZIP ` 3-$ �t(li
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
�M
PERMIT NO. 1_
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $