HomeMy WebLinkAboutX2020-2158 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I j— Residential City of Newport Beach - Building Division �Gd
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 4.0.•"
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Project Address (Not mailing address) r- Flood r Fire r Liq r Landslide rN/A Floor Suite No
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Description of Work
Use F Const Type F
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Valuation
Material/Laa bor
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New/AddSF�— Remodel SF�— Garage/New/ d�_
OWNER'S NAME Last j i i i'� i First t CP
Owner's Address Owner's E-mail Address
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City TIKIti%'�' 1"t I (, State 1 Zip -7 Telephone
APPLICANTS NAME Last' 1 1 First t�i
Applicant's Address Applicant's E-mail Address
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City t�lzkr`\ St/-+- State , fA- Zip rFTelephoneF_
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. F_
Architect/Designees Address Architect/Designer's E-mail Address
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City State r Zip F-- Telephoned
ENGINEER'S NAME Last First Lic. No. S j `I
Engineer's Address Engineer's E-mail Address
City _ �Y`�S� State I 7 Zip q,;Ej,A Telephone 1(I �'27/j'4-IeO
CONTRACTOR'S NAME/COMPANY �F+, j� �t Lic No. F 2_150 Class
Contractor's Address Contractor's E-mail Address
-77 6 16 , r" l D tj/ r � C i 4f511 40.e-Or-/
City f1 rAA State Fa—zipFe)i 7Telephonepm �7o j -2-D
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. - IIM
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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