HomeMy WebLinkAboutX2020-2669 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ore'
Comm'I r" Residential City of Newport Beach - Building Division o jp
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �� RR ,
F_Buildingr Grading F-Drainage F_ Elec rMech r Plum Cu yd Cut Cu Yd Fill F
Project Address (Not mailing address) F_ Flood Fire r Liq [_ Landslide / Floor Suite No
Description of Work Use Const Type F
F- EM6DEL TO VJC Tlvl4 (agsrv�ac.E. KrT'�F�,
# StoriesF_ # Units (if Res)F_
Valuation $
m
5
New/Add SFF-Remodel .' I Z� I' r /Add Material/Labor /0
OWNER'S NAME Last FT
Owner's Address s E-mail Address
; t3 ko►r.t4a'l•0 30 - 20-6100
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State f �A Zip I `j j5o Telephone
City C6 per. t � Vt.
APPLICANT'S NAME Last 1'4,1&_(L.� Q`"'� /7�F- First K (
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Applicant's Address Applicant's E-mail Address
3l $4- B pl y_Vl PAY AeJa
City G��� it"�.riso State Zip Q�� Telephone q 630o
ARCHITECT/DESIGNER'S NAME Last I Y at�� '�') First �a �. Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
336 IS. l-ttl(.t STT !R'[. AN(A1.E -i'l & 0,oL, G()cy
City FL�cj State I GA Zip Qo8'o5 Telephone 949-Q7_Z-4Lp 3)
ENGINEER'S NAME Last First t7 A Lic. No.Z�'1
Engineer's Address Engineer's E-mail Address
IISoo V.. loth, sCT gt.V- tr @, 5 S tell, k . cort
a}}�� AA
City Syi,A-TA �4h State �— Zip QZT0j Telephone 7l+'-B3•r-t&06
CONTRACTOR'S NAME/COMPANY `tA� / ., /Ir' 1 r w Lic. No. ��Class
�1 "'V 1
Contractor's Address Contractor's E-mail Address
-19�'R �IR-w If�/� "� " r roue�t'rutQ. cyw
City GWj7�f-/Q((l /( State �. Zip gz,(ov Telepho e e(4 1912-C30
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS RIGHT PLAN CHECK NO.
SETBACKS LEFT
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $