HomeMy WebLinkAboutX2019-0562 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application Q
FComm" '^Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F Flood F_ Fire F Liq r Landslide F_N/A Floor uite No
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Description of Work
Use ConstType 1/'
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# Stories[— # Units (if Res)F!
Valuation /t
Material/Labor � U
New/Add SFF-- Remodel SF 2�? � Garage/New/Add �
OWNER'S NAME Last M1G�AFirst, 0
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Owner's Address Owner's E-mail Address t
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City A/ �G er �i�di �J State Zip �—' Telephone 9 em
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APPLICANT'S NAME Last II, First A. _ 6
Applicant's Address Applicant's E-mail Address
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City �,. 1 �Inr/_ �j State Zip (j2CV ✓t2, Telephone �jI(�o3Z�j, jgg3
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ARCHITECT/DESIGNER'S NAME Last lG� First !a f�
//� Lic No. ¢
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Architect/Designer's Address Architect/Designer's E-mail Address
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City Fot�4fj 1 i1 r o State G� ; Zip 92103 Telephone &/9. 325. I q90
ENGINEER'S NAME Last First F Lic. No.F
Engineer's Address Engineer's E-mail Address
City State Zip �— Telephoner
CONTRACTOR'S NAME/COMPANY C L/ C,S �„ CD/%SGC L�(•� J Lic. No. 7� Ely G��, Class F
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Contractor's Address Contractor's E-mail Address
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City C()SM 42<s�v State ('A Zip 9Z&2 Telephone 7/L/—S ;�_5e7%
SETBACKS REAR SETBACKS FRONT PERMIT NO.kv �� Z
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE �(,i—S' DEVELOPMENT NO PLAN CHECK FEES $