HomeMy WebLinkAboutX2019-3512 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application ozEWPoa
F_ Comm'I r' Residential
City of Newport Beach - Building Division g
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G< o
F_ Building r Grading rDrainage /lec Mech F Plum CuvdCut CuYdFill l
Project Address (Not mailing address) F Flood r— Fire r Liq F_ Landslide FN/A Floor Suite No
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Description of Work
Use ConstType
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Q\= Ar 1 A C. X.L I#
Stories # Units (if Res)7
Valuation $
Material/Labor J C o uD
New/Add SFF Remodel SF Garage/New/Add F—
OWNER'S NAME Last _ First
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Owner's Address Owner's E-mail Address
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city FN Zhoel 1- .._)3 C N i State I Zip 2 0 Telephone � `i (; -4-14 Z3 Y S
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State F_ Zip F_ TelephoneF—
ARCHITECT/DESIGNER'S NAME Last First
vex Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City �� _ State �C Zip I TelephoneZ'zf}(6�jS
ENGINEER'S NAME Last First Lic. No f
Engineer's Address Engineer's E-mail Address
City State F Zip Telephone
CONTRACTOR'S NAME/COMPANY n � d w �10 S Lic. No. �4o 'Class /3 /
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Contractor's Address Contractor's E-mail Address
City / vC�l f%% State G,� Zip 9y 4 7 Telephone `%Y t
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SETBACKS REAR SETBACKS FRONT PERMIT NO. W(l7
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $