HomeMy WebLinkAboutX2019-1681 - Permit Application�wIC1-le�45I
1=rint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
Comm-[ r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL —
F- Grading F -Drainage r Elec
Address
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of Work
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r Flood r Fire r', Liq r', Landslide rN/A Floor Suite No
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O. NE 'S NA Last I tnG I 1 I _ Ow' First I vU { "
ne s Address ( ner's E-mail Address
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APPLICANT'S NAME Last N u l l s rl c
Applicant's Address
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City �qn , �n i State I
First
Use Const Typed
# Stories # Units (if Res)',
Valuation $ C
Material/Labor F31
Applicant's E-mail Address
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Zip `� Z�.O� Telephone � L.. � I
ARCHITECT/DESIGNER'S NAME
Last I
First I LIC. Ivo.
Architect/Designer's Address
Architect/Designees E-mail Address
State �—ZIP
�— Telephoned—.
City
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Lic.Nof'—
ENGINEER'S NAME Last
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First',
Engineer's Address
Engineer's E-mail Address
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State F_' Zip
TelePhoneF� _.
city
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Lic. No.Fu- UClass h
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CONTRACTOR'S NAMECOMPANY
Contractor's Address
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Contractor's E-mail Address
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City Gq 1 i -1 P�n1
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SETBACKS REAR
SETBACKS FRONT
RIGHT
PERMIT NO. X V o i "1 ,-I "
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PLAN CHECK NO. "` 2-D I9
SETBACKS LEFT
SETBACKS
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $