HomeMy WebLinkAboutX2019-2658 - Permit ApplicationPrint Form W0�4heet for Combo Building & Solar Permit Application QN,
j- Comm'I /Residential ��(\\]] City of Newport Beach - Building Division
'l NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding ( Grading Drainage , EKl: ` C4ech Plum Cu vd cut uYd Fill
Project Address (Not mailing address) f Flood r Fire Liq I" Landslide /A Floor Suite No
�rjo
ell �- �-
Description of Work
Use ConstType FVR
'
/
# Stories #Units (if Res
1
V nation $
terial/L or
New/Add SF �— Remodel SF 5� Garage/New/Add
OWNER'S NAME Last
t" (r (A First 5 CA
J
Owner's Address
Owner's E-mail Address
f5 4L Vvvc
City
State Zip F_ TelephoneF_
APPLICANT'S NAME- Last
raa L� First l (J
Usaats-Addr sCss
F
n Applicant's E-mail Address
City �
State �- Zip �� TelephoneF_
ARCHITECT/DESIGNER'S NAME
( [�- B e kl j F5Lr
Last l U riB�t'} First Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City [
State Zip [ Telephoned
ENGINEER'S NAME Last
First F Lic No.1
Engineer's Address
Engineer's E-mail Address
City �
State I Zip �` TelephoneF_
CONTRACTOR'S NAME/COMPANY
" �(1w� 7 Lic. No. �jQ D %j Class
1 vi /Q�/12 �VG �G
Contractor's Address
Contractor's E-mail Address
t4)e)
fur'7-ti1K��ev��p
City (i 0 z t .,g ►1dLo,!54
��/
State A- GZip y'd X Telephone C, y 1-
SETBACKS REAR
SETBACKS FRONT PERMIT NO. v ' C 1
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $