HomeMy WebLinkAboutX2019-2574 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application o4�W-gym
j Comm'I f4esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_GradingF-Drainage F_Elec F_Mech
Plum Cu vd cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood
F_ Fire r Liq F_ Landslide r_N/A Floor Suite No
�/, 1, %
. 1
s ✓i �f _ S
Description of Work
Use Const Type
# Stories # Units (if Res)F'
-
Valuation $
New/Add SFF— Remodel SFF Garage/New/Add F—
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
L/av *L
� - 4NJLjlif
City t /�Z � C State
Zip Cl� Telephone ��/ �S ZO6
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City L .mot _/L� - _ State I v�
Zip -%� � Telephone 6/lr
ARCHITECT/DESIGNER'S NAME Last
T�[�Dri/�1
First �}
Y/«/L<? Lic No.
Architect/Designees Address
Architect/Designees E-mail Address
City I State 7
Zip F_ TelephoneF
ENGINEER'S NAME Last T7LcXJ/�X�
First D��� Lic. No. e
Engineer's Address
Engineer's E-mail Address
d
City ��/( `S State
C/`i
9ae�� -7/ ,
Zip Telephone ?-9&7-J ,
CONTRACTOR'S NAME/COMPANY
Lic. No. �— Class
Contractor's Address
Contractor's E-mail Address
City Sate
Zip F— Telephone—
SETBACKS REAR SETBACKS FRONT
PERMIT NO. qo II-vnl
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. l B lq
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $