HomeMy WebLinkAboutX2020-1057 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application �EWroR.
Comm'I F- Residential City of Newport Beach - Building Division
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K�Building F- Grading j-Drainage XElec F Mech I-' Plum CudCut� Cu Yd Fill \J //\\
Project Address (Not mailing address) F_ Flood Fire f- Liq ,;"Landslide FN/A Floor Suite No
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Description of Work
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Use [_ Const Type
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# Stories[— # Units (if Res)[_
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Valuation $
New/Add SF - IQ Remodel5ll I�pD�S
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Material/Labor11iiCUJ000
OWNER'S NAME Last l First
Owner's Address
Owner's E-mail Address
City F�—
State
ZIP Telephone
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APPLICANT'S NAME Last First r�
Applicant's Address _
Applicant's E-mail Address1
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city :CAM �j to State i
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Zip C1'�7Z TelephoneF��gq`.�/7�s
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ARCHITECT/DESIGNER'S NAME Last �. �5��
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Firstl�J`-�('-Z�_—_ Lic. No.
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City State �-
Zip r— Telephoner
ENGINEER'S NAME Last
First F__Lic. No.r--
Engineers Address __— Y _—
Engineer's E-mail Address
CityState ri
Zip r Telephoners
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CONTRACTOR'S NAME/COMPANY Lic. N
Contractors
Address
J
� Contractor's E-mail Address _ _ - --
City I State r--4
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Zip r Telephoner—
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �" %DO.7,�_) l
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 17�
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $