HomeMy WebLinkAboutX2019-0177 - Permit ApplicationM,019-0177Print Form Worksheet for Combo Wing & Solar Permit Application o. °�°r
City of Newport Beach - Building Division
F_ Comm'I F_ Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL +,�o.""
Building I— Grading j -Drainage r. Elec r"Mech [Plum Cu Yd Cut Cu Yd rill
Project Address (blot rnailling address) 1- Flood r Fire r Liq r Landslide FN/A Floor Suite No
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Description of Work UsejI;�6rconst Type
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#Stories #Units (if Res)
e Valuation $
New/AddSFF— Remodel SFl-4& _ Garage/New/Add — Material/Labor;lolJ�
OWNER'S NAME Last "��� Ir -2-y✓'y.. First ..
Owner's Address Owner's E-mail Address
...State . Telephone Vw- zipCI G
APPLICANT'S NAME Last�'�1 First
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Applicant's Address Applicant's E-mail Address
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City �!�'-�'t�f State ck Zip L'2��%j��'� Telephone2
ARCHITECT/DESIGNER'S NAME
Last GI�Z� d P -U FirstF PT4 L Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
city J�t�j,/,6jL� - M� Cf-� State Grti zip �T,"C/ Telephone
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ENGINEER'S NAME Last First Lic. No.�
Engineer's Address Engineer's E-mail Adriress
City F_ State Zip F Telephoner
CONTRACTOR'S NAME/COMPANY-R I�jLic. No. .l CIO `l 0(n Class
Contractor's Address Contractor's E-mail Address
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City Irs! i `y_ State CA Zip C?-(olg Telephone FqLlq-(a'1<1 � bc)
SETBACKS REAR SETBACKS FRONT PERMIT NO. A0 I 'I oil I
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 014 , r�4 I a
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ 100. 31
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