HomeMy WebLinkAboutX2019-1359 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application SIM',
Comm'I ( Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing
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Description of Work
Use tip ConstType F
# Stories u #Units (if Res)
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Valuation
New/AddSFr�— Remodel SFr— Garage/New/Addr—
Material/Labor
1
OWNER'SNAME Last If'/A�[+l.,i
First
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Owner's Address
Owner's E-mail Address
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City , (�Uf I.)4 2T &rp7c, N.
State
Zip F— Telephoner.-.-....-...... —
APPLICANT'S NAME Last
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First
Applicant's Address
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Applicant's E-mail Address
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City M-i.155ta,(,(fE`-v
State �_
ZipF � Telephone q {I 630 -k&0
ARCHITECT/DESIGNER'S NAME
Last First �— Lic. No. (---.—
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
City I
State
Zip Telephoners
ENGINEER'S NAME Last
First 5�, e Lic. No. y 5`a4 (,
Engineer's Address
Engineer's E-mail Address
9-0-762 VVId
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City jt4 iSSIOnJ V(CZ-0
State r
Zip �� Telephone Fm ,48f`�f fir,
CONTRACTOR'S NAME/COMPANY
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;'-qof Z_ Lic. No.W2ZZ Class
Contractor's Address
Contractor's E-mail Address
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City P n f ( V
State F C —
Zip q)? )/ Telephone IT/ ?fff4�? 61
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SETBACKS REAR
SETBACKS FRONT
PERMIT NO. 1
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. 0 t�
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $