HomeMy WebLinkAboutX2019-2608 - Permit Application"sem i C�7(_>
/ SOMPrint Form Worksheet ffor Combo Building & Solar Permit Application F_ Comm'] r Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j --Building Grading r`Drainage F_ Elec F_ Mech j— Plum Cu Yd Cot Cu Yd Fill l
Project Address (Not mailing address) [_ Flood F_ Fire r- Liq F- Landslide FN/A Floor Suite No
Description of Work
Use F ConstType v(
# Stories # Units (if Res)
Valuation $ ..
Material/Labor7® �
New/Add SFr Remodel SF Garage/New/Add �®
OWNER'S NAME Last
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last
ALFA?'A First I L e__IAS
Applicant's Address
Applicant's E-mail Address
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ARCHITECT/ D SIGNER'S NAME
Last A/C- N)— First I Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip Telephone
ENGINEER'S NAME Last
r'!/�( First Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City �
State �— Zip F_ TelephoneF_
CONTRACTOR'S NAME/COMPANY/
No. O 63 a56pass
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Contractor's Address
Contractor's E-mail Ad -dress
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AVE ivSrDl lfs 43AM6 17V6a�
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SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.71i Gj
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $