HomeMy WebLinkAboutX2019-0107 - Permit Applicationm�� -0W
e�inti;Form _ Worksheet for �mb�6 Building & Solar Permit Application
F_ Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building r Grading rDrainage i*Elec fYMech Plum cu YdcutF Cu Yd Fill
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide [_N/A Floor Suite No
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Description of Work
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# Stories # Units (if Res)F_
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Valuation $ I{
Material/Labor
New/Add SFF__ Remodel SFI Garage/New/Add F_
OWNER'S NAME Last "�'� �.VI%✓d���..1.✓.'.. First
Owner's Address Owner's E-mail Address
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City Z (Z V iAl F State � Zip "I T'& 1 '7 Telephone - I. l eF_.. '?,o ..-
APPLICANT'S NAME Last ` First
Applicant's Address Applicant's E-mail Address
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City / �� State �� Zip �i-fj �'�. Telephone-2-'G•--�%-7- 2,-�7,V
ARCHITECT/DESIGNER'S NAME Last /YFirst � N L- Lic. No. G I ' (,i
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Architect/Designer'""s��Address Architect/Designer's E-mail Address
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City1�i'-(It/�C%Lr State F7_/__\ - Zip L.�,;.6/ Telephone al � l� •- /. r,Ci' I
ENGINEER'S NAME Last I First Lic. No.F
Engineer's Address Engineer's E-mail Address
City ,.. State Zip [_ Telephoned
CONTRACTOR'S NAME/COMPANY / 5 Lic No.6 f-QO Class
Contractor's Address Contractor's E-mail Address
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City rJ lyl(i State. Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. iZ�\� — Q I O 7
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. (1y7��� _ Z0 i�
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $-N' I Lis, S S
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