HomeMy WebLinkAboutX2020-0739 - Permit ApplicationPair t Form Worksheet for Combo Building & Solar Permit Application
Comm', F, Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building (,Grading F_Qrainage [Elec [,Meth F. Plum Cu Yd Cut Fi Cu Yd Fill
Project Address
of Work
Flood ❑ Fire F�— Liq ❑ Landslide F7N/A Floor Suite No
1-7
New/AddSFF—- Remodel SFF__1
OWNER'SNAME Last
Use I I ConstType F'
# StoriesC # Units (if Res)[;
� Valuation $
I Material/La
First i 1 A A
Owner's Address Owner's E-mail Address
City pCf (tJ�12 f -. %j iv,�.L+l! f State ` i4 Zip Telephoned
APPLICANT'S NAME Last First l`� p OW/I i
Applicant's yA�ddress ,2 , / Atp—plicanfs E-mail Address
l AVP� rJilC%�:l- V['r' �(�'i4 I t-'I YR- reC✓C��A%� �5fZ1�/L7�Ji�l.��C'i
City i State )Xi cb
i��-IPit�Jt���� P �/� �! Zip , Telephone
ARCHITECT/DESIGNER'S NAME Last First F Lit No.
Architect/Designer's Address
City - State
Architect/Designer's E-mail Address
Zip �'I Telephoned
ENGINEER'S NAME Last td//,f/ x. C First s 6 2 Lic. No.F
Engineer's Address
et yp•Z
City 0 f.i State FL4_;;—
Engineer's E-mail Address
Zip F—TelephoneF
CONTRACTOR'S NAME/COMPANY ri Lic. No. Class
Contractor's Address
127--A ve, 18_weir
city�� ,r. - State
- ___ _ . _TT ...
SETBACKS REAR SETBACKS FRONT
Contractor's E-mail Address / /
Zip L�-' L TelephoneCZYC/_
PERMIT NO. X 7ii
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $