HomeMy WebLinkAboutX2019-0050 - Permit ApplicationAl
Print Form Worksheet for Combo Building & Solar Permit Application
F Comm'I r Residential City of Newport Beach - Building Division
ninTF- pi AN] (.HF(.K FFFS DUE AT TIME OF SUBMITTAL
rBuilding r. Grading rDrainage rElec r!,Mech r, Plum CuvdCut Cu Yd Fill
Project Address (Not mailing address) rl Flood r Fire n Liq r Landslide r'N/A Floor Suite No
Description of Work 04 C ( — —
Use F Const Type I
#Stories#Units (if Res)
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4as"K tl6Q
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Valuation $
Material/Labor
New/AddSF—', Remodel SFF Garage/New/Add —',
OWNER'S NAME �/.( tl
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Owner's Address Owner's E-mail Address
7G R - i5J
Telephone
City,p,P/F--t (�ra^.iGG"t- State ��}_ ZiP /Zd
APPLICANT'S NAME.
11
Applicant's Address + Applicant'ss E-mail Address
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731 _NCAIV .{f_4A�/ rVt
City %1Y7 _ State I ` Zip Telephone Z3r'Z!
ARCHITECT/DE'SSIIGNER'SNAM y u un D /� Lic. No. 9a(a(pJ�j
Architect/Designer's Address Architect/Designer's E-mail Address
City - State r—, Zip Telephone�—
ENGINEER'S NAME Last F First Lic. No.�—;
Engineer's Address Engineer's E-mail Address
City State —:, Zip �— Telephone—
_.__ -...._ _.. _ ....
CONTRACTOR'S NAME/COMPANY TWMC-W,n W lot, �jQ Lic. No. �: Class / (� 445
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Contractor's Address J 83 D Contractor's E-mail)7Address
731 _... (F� v �J �J
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State �—
p �, ,% /J Q Zip Telephone ftZIZ/—
City Gi
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. •'LQ�
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $