HomeMy WebLinkAboutX2019-0341 - Permit ApplicationPrint Form I 1 Worksheet for Combo Building & Solar Permit Application a nm
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sidential City of Newport Beach - Building Division ygom-Q.5r41 o f
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL09 3 - lq
Building r-Gradingr'Drainage F_Elec �Mech Plum Cu Yd Cut . Cu Yd Fill
Project Address (Not mailing address) F_ r" Fire r" Liq F Landslide rN/A Floor Suite No
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Description of Work
User Const Type
Stories[ # Units (if Res)F7
Valuation I
Material/Labor l/ G0 G(l
New/Add SFF Remodel SFdddddd� Garage/New/Add
OWNER'S NAME Last ._f.I 'ji ��jyJ/�j / -- . First
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Owner's Address Owner's E-mail Address
City (l (�✓1%�.. State
Tr FTI_` Zip T`ellephone r`l, 7-o _. )-z
APPLICANT'S NAME Last -1� First/(
Applicant's Address Applicant's E-mail Address
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City �( {_' - State C /k Zip L'7. 71%=' % Telephone �-v - 1 L,� - Z-� 2,vARCHITECT//DESIGNER'S
NAME Last 7I � iY���
First Lic No. F71I01C
Architect/Designer's Address Architect/Designer's E-mail Address
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Cit i'-lIt/' G Cj� State Zi Z �' l Tele hone �r -
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ENGINEER'S NAME Last First Lic No.F—
Engineer's Address Engineer's E-mail Address
City _ State J Zip Telephone�—
Qq Class
CONTRACTOR'S NAME/COMPANY /r 'y Lic. No.Fq-
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Contractor's Address Contractor's E-mail Address
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City /���/`/. State Zip �(�. Telephone q
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SETBACKS REAR SETBACKS FRONT PERMIT NO, xUl - 0u
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. O29j��2pl_1
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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