HomeMy WebLinkAboutX2019-0858 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application WPM
City of Newport Beach - Building Division G
Comm'I ResieI
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building , [Grading
[Drainage Elec ❑Meth Plum Cu Yd Cut
cuvdrin
L_ J
Project Address (Not mailing address).'C� Flood `n Fire j uq .F Landslide .-CN/A Floor Suite No
C�
,C `ice=foo'
Description!of WOK
Use ;Lonst Type,
i
Stories, # Units (if Res)
�tla
New/Add SF
_
Remodel SF�� ��ZL Garage/New/Add
Valuation $
QWNER'S'N%UG1E
Last`<„
J
=
Owner s Address
Owner s'E-mail Atldress
State Zip �� Telephone-
rCity`..�'
ARPLICANT'S NAME
Last`: � Q "First
Applicants Address
Applicant's'E-mail Address
Gity<�TCt4
State Zip
�a ro Telephone g�`�
%►RCHITECT%DESIGNER`S NAME Last:
First
LIC. Nm,
'
I
Architeo_esigner'sAddr
ifectlDesigner.'s,E=nail Address
Fk
Cify
,`
State Zip
l Telephone
t
v
I
\
ENGINEER'SNi�ME J
Last
First
Lje
Eng)neer s Address. `_
Engineer's E-mail'AtltlreSs '" "
iG
i
City
State Zip'-;
,e tie¢e
CONTRACTOR'S NAME/COMPANY. Lic. No. �C� class
Contractor's Address'
Contractous;F{majl Address
cr-
69_Goi.Q iA-d-l"�av tX4 cub. GO�'lI
�Li
6.J.t
L
Ci
1 aa_-'•J nd, k R +rYGh A,+- 5d..«.:_ ? ? A, �� WA p
..i
State Zi
L� 4lo�
�.( ry9L:�GuaYa.l�J3xll
nM sFYx4WW4f4 vtc$p�.+Ff a..}' "'�tm+�6i4 A'S�unW[.+uh.4l'M'
J Tele phone
8
SETBACKS REAR
SETBACKS FRONT PERMIT NO..
SETBACKS LEFT
SETBACKS'RIGHT ' PLAN CHECK N0. %1
,
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $