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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 $