HomeMy WebLinkAboutX2019-0553 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
r Comm'] r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
I -Building F7Grading I -Drainage j-Elec F-Mech rPlum Cuvdcuti Cu Yd Fill
Project Address (Not mailing address) C Flood r Fire r- Liq r Landslide CN/A Floor Suite No
Description of Work
Use F_ Const Type
# Stories # Units (if Res)[—
valuation $
Material/Labor9 1 00
New/Add SFF — Remodel SF�— Garage/New/Add �—
OWNER'S NAME Last iv►'ri�Pm-r rt,;.--S--T First
Owner's Address Owner's E-mail Address -
City I r.W_u ks State 6 4� _ - Zip 1 G Telephone 4 4 q 411 O9 s -
APPLICANTS NAME Last (A -` 14 Firsti, f oV Cr US ---
Applicants Address Applicant's E-mail Address
11-141, (AM40iii l
City S N �. _ State I CP __ Zip _ j OS. Telephone -7' g 1 19 I
� !� - � Nli l..11'�r
ARCHITECT/DESIGNER'S NAME Last �- First �— Lic. No. �—
Architect/Designer's Address ArchitecUDesigner•s E-mail Address
City �— State F Zip F TelephoneF—
ENGINEER'S NAME Last I rA d First q I A V (y Lic. No. Sj
Engineer's Address Engineer's E-mail Address
City F&_! An tk 4 N (41 ,, State 4q Zip F97.7O S- Telephone -714 60, vs o
CONTRACTOR'SNAME(COMPANYGo a Si Lic.No. G3]14b Class
r/lrUS Stew �: �+
Contractor's Addrrees-s Contractor's E-mail Address
_ )�3k-1 (AA/[a110IV N:,CL F
State L ZipR%1 �j 0 S� Telephonel
City _ St1 N T
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. XUA 053
PLAN CHECK NO.
PLAN CHECK FEES $