HomeMy WebLinkAboutX2019-0729 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application ,ETo�M
F Comm'I r Residential 0499--201f City of Newport Beach - Building Division J(a019-07.29 mq
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL w
fK Building (" Grading j -Drainage X( Elec r - Meeh r- Plum cu ydcutr Cu Yd Fill F
Project Address (Not mailing address) r Flood f- Fire r Liq J- Landslide J -N/A Floor Suite No
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Description of Work CU Pis
Use F5 Const Type lA
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#Stories Units (if Res)
New/Add SF Remodel SF rlGarage/New/Add ��
Valuation$ 'h
Material/Labor ;01000
OWNER'S NAME Last 16J6nl9v 16 First Dk4ffl0o7 ffin)IQ_Wwy rbs;uil
Owner's Address Owner's E-mail Address
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City Nku7?o PIE ` ---.._6/164-...__..State CA, Zip � Telephone _-1t('1-%/�A.'%M
APPLICANT'S NAME Last vkc� First l7
Applicant's Address if*5 0 ex Nr*0A4-q A6 LAA Applicant's E-mail Address
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City Wi State Zip g2(,tg� Telephone qkq-671.610go
ARCHITECT/DESIGNER'S NAME Last �— First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State � Zip �— TelephorieF_
ENGINEER'S NAME Last'Pt*54, it4 First Lic. No.
Engineer's Address TK S' V Engineer's E-mail Address
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City `�1(J�j State— Zip J2 t � Telephone gtiq %5J - GJ600
CONTRACTOR'S NAME/COMPANY G 4,0 C.O ��� LCL Lic No. 1 -79 070(o Class
Contractor's Address Contractor's E-mail Address
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City.I j J� State C� Zip Telephone a4q 7`f (dig
SETBACKS REAR SETBACKS FRONT PERMIT NO. j_Zp 19 — o -7 ZG
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. OLrar7 - z_0(,5�(
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $