HomeMy WebLinkAboutX2019-0910 - Permit ApplicationOM-mv
Print Fora; Worksheet for Combo Building & Solar Permit Application of- P-01'
❑ Comm'I ❑ Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Gu.oa�•'
❑Building E] Grading ❑Drainage ❑Elec ❑Meth ❑Plum CuvdCut F-7 Cu YdFill F71
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
II®:-�d(J�S,II I 1 1
New/AddSF Remodel SF �� L Garage/New/Add
OWNER'S NAME Last
First
Owner's Address Owner's E-mail Address
X 105
City�j.pu,,t\ State Zip Fq Te
APPLICANT'S NAME Last
Applicant's Address
5(q! -5 C (' 6 7eV4(111
City LONG tqC ,A State /` /� Zip
First
Use ® Const
Stories # Units (if Res)❑
C,AAA i i , Co A4
Applicant's E-mail Address
TelephonelJb�b6
ARCHITECT/DESIGNER'S NAME LastFirst
10 L r/S 1� � L J Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
5l L (�(C� Cd
City State I (. ZipW"
Telephor
ENGINEER'S NAME /Last -4-�Fii(rst Lic. No.C7J
Engineer's Address
City State
CONTRACTOR'S NAME/COMPANY
Engineer's E-mail Address
Zip Telephoned
Contractor's Address
City .,._._ State
SETBACKS REAR
SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
USE ZONE
DEVELOPMENT NO
Lic. No.GJ3a3 Class
Contractor's E-mail Address 31 Za
Zip Telephone��l
PERMIT NO. VXZDkC1,1- ('q,
PLAN CHECK NO.
PLAN CHECK FEES $0 1�2 0