HomeMy WebLinkAboutX2019-2094 - Permit ApplicationPrint Form 1Nor!%hee
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t or Combo Building & Solar Permit A lic t'
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r COmm'I F Residential City of Newport Beach - Building Division _
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL n�
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Project Address (Not mailing address) FFlood r Fire Liq f— Landslide FN/A Floor Suite No
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Description of Work y�
T-7c �`1J�i Use F ConstType�
C # Stories # Units (if Res)s
New/Add SFr—' Remodel SF�— F—; Valuation a
' Garage/New/Add Material/Labor
OWNER'S NAME Last
First�,�-
Owner's Address
Owner's E-mail Address
City Wp�1Mtit� - State G� ZIP
�( j K,' Telephoned
APPLICANT'S NAME Last
First
Applicant's Address Applicant's E-mail Address
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city _ State Zip F— Telephone���"
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ARCHITECT/DESIGNER'S NAME
Last First �— Lic. No. F—'
Architect/Designees Address Architect/Designer's E-mail Address
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City State Zip F i Telephoned
ENGINEER'S NAME Last
First F� Lic. No.r--
Engineer's Address Engineer's E-mail Address
City ._ State F_ Zip F_ Telephone[
CONTRACTOR'S NAME/COMPANY — �Lic. No. [re,P/! _ Flo 173TL_ Class E-2
Contractor's Address Contractor's E-mail Address
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City Got I 'qe g State 4- Zip ( four 23_ TeIe hone
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SETBACKS REAR SETBACKS FRONT PERMIT NO. ciI y
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. rJJ(
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $