HomeMy WebLinkAboutX2019-0375 - Permit ApplicationX 20tcl — b31'5
Prliit`Fvmi: Worksheet for Combo Building & Solar Permit Application
r7Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Cu YdFill I
Project Address (Not mailing address) I— Flood
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FN/A Floor
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Suite No
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Description of Work
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New/Add SF� Remodel SF 2310
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UseO ConstType�—
'F3'ncT�'NES DEW(o OF
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Garage/New/Add I o Material/Labor F5K
OWNER'S NAME Last l '("%AZX2Pt First ANTE....
Owner's Address Owner's E-mail Address
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APPLICANTS NAME Last
Applicant's Address
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NAME Last �dcryEr(u
Architect/Designer's Address
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Last
Engineer's Address
City. .. .....State-,
CONTRACTOR'S NAME/COMPANY ! t)3 f3 E
Contractor's Address
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First
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Applicant's E-mail Address
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Zip "l -cr C'. Telephonfe i j C'/ �'�'% �, % 7_
First (t,C('Trfi�2t_ Lic. No. `i
Architect/Designer's E-mail Address
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Zip F(ZG. i o Telephone 10) 111 1(, (S
SETBACKS REAR ' C 1=r SETBACKS FRONT 0
SETBACKS LEFT 'o SETBACKS RIGHT d
USE ZONE G V DEVELOPMENT NO
First— Lic. No.1--
Engineer's E-mail Address
Zip [ Telephoner
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Contractor's E-mail Address
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Zip I�G3 \ Telephone
PERMIT NO. X"II- )j -Is
PLAN CHECK NO. 054-201"1 _
PLAN CHECK FEES S