HomeMy WebLinkAboutX2019-2803 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach -Building Division yJ d o
F- Comm I jy Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTALS ` )
r -Building F_Grading F -•.Drainage r`Elec F_Mech F- Plum CuvdCut CuvdFill
Project Address (Nott mailingaddress) F_Flood F-' Fire r Liq r- landslide F_N/A Floor Suite No
Description of Wojkl
Use F Const Type
# Stories # Units (if Res)s
ua!New/Add
0alabor
_i_
SFRemodel SF�Garage/New/Addr—
OWNER'S NAME Last First >
Owner's Address
Owner's E-mail Address
City State �—.-.-. Zip F— Telephoner---.-�.���-��-_��-���..
APPLICANT'S NAME Last �, � ��
First I /tA6 V\. Ir,,
Applicants Address
Applicant's E-mail Address
es
City I C651 -c-, yY,.csc,State
Zip. (Ii /; Z7 / Telephone
+' t
ARCHITECT/DESIGNER'S NAME Last ��
First I - -- tic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
,ci{y State F
Zip F— Telephoned
ENGINEER'S NAME Last �—
First F_ Lic. No.F—
%Engineer's Address
Engineer's E-mail Address
City State �-
Zip-- - Telephone—
CONTRACTOR'S NAME/COMPANY $Ik / ?� 1. J 1 d I C Lic. No. eo Class
(P
Contractor's Address
Contractor's E-mail Address
11 ( fllvl(�N Jr
4 ,v c e;'
City �/1G: •� 5 State �t�q -
Zip X710 Z `� TelephoneF,0
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $