HomeMy WebLinkAboutX2019-3579 - Permit Application_Print Form
Combo Building & Solar Permit Application
Comm'I�' Residential 1 ;I City of Newport Beach - Building Division r
- NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL L 1VI I apa,P
(`Building [ Gradingainage [ Elec [7,Mech r Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood r_ i e q F_ Landslide j -N/A Floor Suite No
Description of Work ( Use ?EF Const Type FR7T
o-6, ' c@ss
# Stories _7 # Units (if Res)
—J
Valuation $
New/AddSFF------ Remodel SF '�� Garage/New/Add Material/Labor VOC)
OWNER'S NAME Last
Owner's Address
20& 3C)fi� S ,
city _ �. i3 _ —
APPLICANT'S NAME Last
First
Owner's E-mail Address
State C Zip
Applicant's Address
3 t� Co keen
City r1 -- —- - State C---
266
First I AJI,c ,el Cq—
Applficant's E-mail Address
a7C teal, aA i Q"54_ ,-., C.
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Zipr 2 i Z '% _ Telephone
ARCHITECT/DESIGNER'S NAME Last First 177777 Lic. No.
Architect/Designer's Address
City State;
Architect/Designer's E-mail Address
Zip F— Telephoner_ --
ENGINEER'S NAME Last ' First r_ -- Lic. No.F --
Engineer's Address
---------------------- ------------------
City State F
Engineer's E-mail Address
—---------------------------- -
Telephone)—�--,
CONTRACTOR'S NAME/COMPANY i 4 Lic. No. P�J Class Lz o
Contractor's Address
jC t c 11e�✓ - -ei=-- - - — --
CityC,)n State
---- - - --- --- ---
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
Zip 612(Z I Telephone��f _756 0004
PERMIT NO.
PLAN CHECK NO. 2__�ISLefLki C
PLAN CHECK FEES $