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HomeMy WebLinkAboutX2019-3672 - Permit ApplicationZ_4 Print Form Worksheet for Can- io Building & Solar Permit Application dE Rr Comm'I Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL wilding Grading ("Drainage F�%Elec blech -( um CuYdcut O CuYdFfll F_ Project Address (Not mailing address) F Flood F` Fire F Liq f- Landslide LAN/A Floor Suite No Description of Work }//yJ 4 �/�. �� Use F_ Const Type # Stories # Units (if Res)[ 41 i �A v� Valuation $ New/Add SF odel SF /9d Garage/New/Add (� �,� Material/Labor - -- - I_ OWNER'S NAME Last 9 - _59rt///D!/tJ7 First y� ' ------ ------ -- - Owner's Address / Owner's E-mail Address City - ✓Par°State -C,,f ZipTele hon -- �- - APPLICANT'S NAME Last WA(:� ^!-1 First yf Applicant's Address Applicant's E-mail Address be/A r City I VC-VJ p0,.,.V- (der t >` State C'?/� Zip GT'y 6 g- - Telephone ARCHITECT/DESIGNER'S NAME - ?/ Last Lic. No. -7 C7�� `� S Architect/Designer's Address Architect/Designer's E-mail Address - I City State F— Zip � P Tele hone ENGINEER'S NAME Last F� First _ Lic. No.F— Engineer's Address , 3 Engineer's E-mail Address f •_ v - � ��� - City State F Zip F— TelephoneF� CONTRACTOR'S NAME/COMPANY �ci n 1� ✓�RRis©. I607,d Lic. No. 7 -7qS- Class f Contractor's Address City �'Ufi CpGsl" State SETBACKS REAR SETBACKS LEFT USEZONE SETBACKS FRONT Contractor's E-mail Address /� � c� •�e�� �'_ c1 �� ,'�. dam Zip Qf� `$" Telephoner!) �ZO PERMIT NO. X Z-0 l9 -7' SETBACKS RIGHT `v DEVELOPMENT NO PLAN CHECK NO. PLAN CHECK FEES $ 6-1,111 01 e" P)