HomeMy WebLinkAboutX2019-0560 - Permit Application (2)Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
r Comm'I F' Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r'Building r Grading r'Drainage (- Elec
roject Address (Not 11113811111
1 (smunl-a _ C-`
escriotion of Work _
New/Add SFF — Remodel SF
OWNER'S NAME Last
F_ Mech F_ Plum Cu yd cut I Cu Yd Fin l
F• Flood j- Fire F- Lig F- Landslide F -N/A Floor Suite No
Use F Const Type
# Stories # Units (if Res)F
Valuation $
Garage/New/Add —'. Material/Labor Fq
- � oo
Car.T First
Owner's Address Owner's E-mail Address
'1D1 rWT4K zp17 S�
City �— _ ... _ State FC A—zip 11-1 C:' Te
APPLICANT'S NAME Last FS t t tr
Applicant's Address
113441- CAWyou cZ
City SI A*n A _.A IVA State
ARCHITECT/DESIGNER'S NAME Last
First) `.ING,✓S
Applicant's E-mail Address _
Zip �,L_7 CO r Telephone -7 (4 J � 1? It q I
First
Lic. No. F�
Architect/Designers Address Architect/Designers E-mail Address
City
State ..
Zip F TelephoneF�
ENGINEER'SNAME Last X1 pit)
Engineers Address
►s—�-b iitzoo�c.�aoc�.nw X45
City _ S N State G
First' "Q I A S G, Lic. No. FJ::, g
Engineers E-mail Address
Zip fj'11%0_5- Telephone 714 66, dSIL>
Lic. No. 1637 4 40 Class is
CONTRACTOR'S NAME/COMPANY ���US Ste, ITt-F L OUST
Contractors Address Contractors E-mail Address
State Ci T Zip . 1 �.-7 O S Telephone '� I L► �3 g I r g I
City .. �a11� T-�' _. _ 4'TA/ i�
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. _
PLAN CHECK NO.
PLAN CHECK FEES $