HomeMy WebLinkAboutX2019-1110 - Permit ApplicationPrint Form J. WorKsneet for combo building & Solar vermlt Application
FComm'I Kxesidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F Flood
F_ Fire (J Liq I— Landslide FN/A Floor Suite No
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Description of Work
Use F—ConstType F
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# Stories #Units (if Res)
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New/Add SFF— Remodel SFFWU-- Garage/New/Add I�—
Valuation $
Material/Labor q*,
OWNER'S NAME Last woo
First �'T� ✓E
Owner's Address
Owner's E-mail Address
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City CARD j} L �,>fFR State 0.4
Zip —75- Telephone
APPLICANT'S NAME Last / I�D
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First -S72�1/9
Applicant's Address
Applicant's E-mail Address
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City �� p� �� /' X State G�
Zip p= �5_ Telephone
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ARCHITECT/DE GNER'S NAME Last D First K Lic. No. I 7
Architect/Designer's Address
Architect/Designer's E-mail Address -:�p , t
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City State
Zip TelephoneF_
ENGINEER'S NAME Last
First Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State F
Zip j Telephone
CONTRACTOR'S NAME/COMPANY
_kic. No. Class
Contractor's Address
Contractor's E-mail Address
City I State F__
Zip � Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. x�Z)joi_0
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. r> �-l. "� • 2. I ��
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $