HomeMy WebLinkAboutX2019-3931 - Permit Application-z T c
Print Form J Vyorkieet for Combo Building & Solar Permit Application Q
�Comm'I esidenti City of Newport Beach - Building Division l l- 3C131
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL X I
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of Work
New/Add SFF77777 Remodel SF
OWNER'S NAME Last
Owner's Address �, (� %
Use '�., ConstType
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# Storiesr____�_ # Units (if Res)F
Valuation 5 !'�
Garage/New/Add ��� Material Labor S OO D i
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1 C r(_I7wrrer's E-mail Address
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City 9__ State ]]li Zip �I, Telephoned' f
APPLICANT'S NAME Last
Applicant's Address
City '_ - State
First
Applicant's E-mail Addre6�.
Zip � ��I Telephone
�s �� - Architect/Designer's First ,Y`.JJ
NAME "Last Lic. No.
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ct/Designer's Bn
fiii Address
City - --_ - State F77 Zip
ENGINEER'S NAME Last - -l�_r l`t`e-- __- - -- First Ui� Lic No.VZ7LGe-J,
Engineer's Address
City - State
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Engineer's E-mail Address
Zip Telephone
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CONTRACTOR'S NAME/COMPANY r)/1 �r-/�,`„ I.r � -l-�Lic. No. [1057�,7zClass�
Contractor's Address
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City () I State _.
REAR SETBACKS FRONT
Contractor's E-mail Address
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Zip q Z _. Telephone
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PERMIT NO. 11", 1`11
LEFT SETBACKS RIGHT
PLAN CHECK NO.
ZONE DEVELOPMENT NO PLAN CHECK FEES $