HomeMy WebLinkAboutx2019-1699 - Permit Application (2)Pint Form Worksheet for Combo Building & Solar Permit Application ygjgp�
City of Newport Beach - Building Division' !,(� ° , , l i t31 Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
"Building F` Grading i --Drainage r Elec I— Mech F— Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F Flood F Fire r Liq F_ Landslide FN/A Floor Suite No
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Description of Work eUL
Use dnst Type F_
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Stories # Units (if Res)
New/Add SF Remodel SF tiara a/New/Add
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Valuation $ P� �\
Material/Labor / Jjo 6
OWNER'S NAME Last�I ki r ) First e T'7 PI a P-,
Ownegr'sg Address Owner's E-mail Address
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City tv&jPC r � C CXc5 i- State ' L � _ Zip C� it1 i .r Telephonel_. _...._._,_
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APPLICANT'S NAME Last A d� tltL7 First
Applicant's Address Applicant's E-mail Address
City J"� � l k9t�_ _ State C Zip 2 S Telephone
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ARCHITECT/DESIGNER'S NAME Last— ey j LCA First % S 4Ln Lic. No.
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Architect/Designer's Address Architect/Designer's E-mail Address
City I� State F_ Zip � Telephoned
ENGINEER'S NAME Last yr f_
i First, i Lic. No..Lm
Engineer's Address Engineer's E-mail Address
City State 'Zip Telephone
CONTRACTOR'S NAME/COMPANY> Lic. No. Class t
,�i� C(,1
Contractor's Address Contractor's E-mail Address
City ` State "y Zip q Z70 "' Telephone
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. }
PLAN CHECK N0.
PLAN CHECK FEES $