HomeMy WebLinkAboutX2019-0275 - Permit ApplicationP i t Form Worksheet for Combo Building & Solar Permit Application (069i��lq '0Z� City of Newport Beach -Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_Gradingr-Drainage r7lElec F*ech Plum Cu Yd Cut F_Cu Yd Fills
Project Address (Not mailing address) F_ Flood r- Fire r Liq r Landslide r -N/A Floor Suite No
Description of of Work
UseConst Type
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it Stories # Units (if Res)s
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Valuation $ /o
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Material/LaborFF—
New/AddSFI— Remodel SF Garage/New/Add
OWNER'SNAME Last -t l 1y � V�Jdl�'Y First
Owner's Address Owner's E-mail Address
City State Zip L%' TelephoneMC.. ZO
APPLICANT'S NAME Last �� i First 11 zK
Applicant's Address Applicant's E-mail Address
City�Y f? !).j State L�A Zip T'Z7f-�_4-1. Telephone FC2 '2,32,V
ARCHITECT/ /DESIGNER'S NAME LastLic First �� Yr �[ I - No. G
%f G �` % �-�
Architect/Designers Address Architect/Designer's E-mail Address
Ci G State Zi
ry 'Y✓�Gs 13� 1, I "(` P '1-2-774' . Telephone s�Gl-=.Li"1'�zi�
ENGINEER'S_ NAME Lasts First Lic. No.F
Engineer's Address Engineer's E-mail Address
City ,.. State r— Zip Telephoned—
CONTRACTOR'S NAME/COMPANY pt%Jy , Lic No. mR�l� I Class
Contractor's Address Contractor's E-mail Address
—
City State F_ Zip F_.. TelephoneI
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Q1gq. 110t"1
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
k n qo
19Gig