HomeMy WebLinkAboutX2020-0943 - Permit ApplicationPint Form Worksheet for Combo Building & Solar Permit Application flod�
Comm'I [ Residential City of Newport Beach - Building Division �j�0— � 1(�
NOTE: PLAN CHECK FEES nI IF AT TIMF nF aI lanniTTAI
KBuilding ❑Grading ❑Drainage AElec AMech 1Y Plum CuYd cut JJCu Yd Fill
Project Address (Not mailing address) [ Flood ❑ Fire ❑ Liq ❑ Landslide (-JN/A Floor Suite No
00 /Il a �R • C _ ✓, la Gar ! _ 1
Description of Work b �j - 0 *-U [ AK1 t✓ A
AL /� ' �flxR� G CIS ��G%N - Use I onstType
14� �� OR i O i A Il # StoriesC # Units (if Resci
Valuation $
New/Add SFF Remodel SF -I Garage/New/Add Material/Labor
OWNER'S NAME Last��� First
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Owner's Address Owner's E-mail Address
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City �T�IJ�Pi i ---
State �� Zip y Telephone U
APPLICANT'S NAME pj j�
Last`' 1------- First --- -----�
Applicant's Address _t Applicant's E-mail Address
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City LORM4, i state C a` I Zip z�OQ TelephoneyO
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ARCHITECT/DESIGNER'S NAME Last —1
First �4L i
—� Lic No.
Architect(Designers Address Architect/Designer's E-mail Address f
City I low w �- - � /rc � State �! zip 'Z6fj [f Telephone Q T/5.6�I el 4
ENGINEER'S NAME Last _ _ _ - -_ First F j Lic. No.F—I
Engineer's Address Engineers E-mail Address
City State j Zip Telephone
CONTRACTOR'S NAME/COMPANY - I U �� PM� j Lic. No.Class l
Contractors Address tt uw "j�xw does E-mail Address tillpNI
City-" State Zip M2 �.21L Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
x�/�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. f' l h73 ZOZ
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $