HomeMy WebLinkAboutX2019-3727 - Permit Application (2)92-0101-142--t
`'.! Worksheet for Combo Building & Solar Permit Application
❑ Comm'I ❑ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL V c�,o„„•�
❑Building F] Grading ❑Drainage ❑Elec ❑Mech ❑plum Cu yd cut Cu Yd Fill
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Project Address (Not mailing address) [I Flood [7 Fire ElLiq F] Landslide ❑N/A Floor Suite No
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Description of Work
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Use Const Type
# Stories❑ # Units (if Res)❑
New/Add SFII Valuation $
Remodel SF Garage/New/Add — Material/La6o
OWNER'S NAME Last f
First
Owner's Address Owner's E-mail Address _ f s/
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City State Fa7 ZiP Telephone
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APPLICANT'S NAME Last
First ��...-..
Applicaanntt'-sua Address p 1 Applicant's E-mail
Address
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City�� 5i. State Zip Telephon ,4, ,� s
ARCHITECT/DESIGNER'S NAME Last
Address
City
ENGINEER'S NAME
First � Lic. No.
Architect/Designer's E-mail Address
State ® Zip �_ Telephone 1K-3�
Last I ' r 151,T —� First Lic. No.
Engineer's Address Engineer's E-mail Address
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city JY�ry uL� State ►J Zip® Telephone 5 2�
CONTRACTOR'S NAME/COMPANY �iM__ i(_' �
f�k %N Lic. No. 7� ClassCtp,gCl
Contractor's Address Y `�"^JlttcS7 Contractor's E-mail Address �Lv�
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SETBACKS REAR SETBACKS FRONT PERMIT NO. Y7 n 1--1 _ :�
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO�7 6 PLAN CHECK FEES $