HomeMy WebLinkAboutX2019-2837 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application a�` i,,
- Comm'I rj�Residential City of Newport Beach - Building Division 6 '
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL „.''
Building F Grading rDrainage r✓Elec rfMech Plum Cu vd Cut F_Cu Yd Fill F_
Project Address (Not mailing address) F_ Flood F Fire F- Liq r- Landslide FN/A Floor Suite No
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Description of Work 3
Use ConstT e
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# StoriesF3 #Units (if Res)
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Valuation$ P i 6 0
Material/Labor 14 b
New/Add SF Remodel SF Garag a/New/Add
S12 uw�}s
OWNER'S NAME Last ��,1�lLen First 6PAon '5xq (
Owner's Address Owner's E-mail Address
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IirU�(�„k"1� iR�l�a,�.}� ��" Zip q`i �61i D Telephone q`{r1 7), .6q(j
APPLICANT'S NAME Last" COYTI U0 First a' Qe I
Applicant's Address 1 %5 V Srt. Applicant's E-mail Address wac (jrncj,3 Do'n .
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City n-� &In pgoState F�ji Zip t �ln ,relephone )'I 4� ll ` 7a�(' �'I
ARCHITECT/DESIGNER'S NAME Last Vri�ul First itQvl Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City j00 W6 V State � Zip (�I DJ Telephone FCC, , q'- 3
ENGINEER'S NAME Last First F Lic. No f
Engineer's Address Z�jEngineer's E-mail Address
City State F Zip F— Telephoned
CONTRACTOR'SNAME/COMPANY li I Inc Lic No. ��2� Class
Contractor's Address Contractor's E-mail Address
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City 'fit I_`iMY State 7F_ Zip a Telephone � I��
SETBACKS REAR SETBACKS FRONT PERMIT NO. a\"\ '2,0
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. po
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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