HomeMy WebLinkAboutX2019-1774 - Permit Application,1155107
Worksheet for Combo Building & Solar Permit Application j k
r Comm'I Residential City of Newport Beach - Etuilding Division
NOTE: PLAN CHECK.FEES DUE AT TIME OF SUBMITTAL `4Foa^
Building Grading Drainage F-Elec r-MachPlum,; cuvdcut' cuvdFin
Project Address (Not mailing address) r Flood F- Fire r Liq F- Landslide ;FL N/A Floor Suite No
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Description of Work �^ Use Jz-2 Const Type'
3 Pa 3,5 12-610,- z, s 12a ry s /,s g -f
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3� Valuation$ oN
New/Add SF ' ✓ Remodel SF Garage/New/Add �— Material/Labor �t70� p p
i OWNER'S NAME
Last 00L-D�EKDTJ First
Owner's Address Owner's E-mail Address Lir
City �K)� �' State Zips Telephoner
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APPLICANT'S NAME Lastl First
Applicant's Address Applicants E-mail Address
j City �A 'Pa, /tkA-P-, State ICA Zip % Z Telephone q� 62-7,%
ARCHITECT/DESIGNER'S NAME Last IQ Gel Z First Lic. No.
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Architect/Designers Address Architect/Designer's E-mail Address
sM�ot5 _ _
City F State F Zip F `- Telephone
ENGINEER'S NAME Lastt ''(�i� Z FirsL Lic. No.'—
Engineer's Address Engineer's E-mail Address
SIM �5 aU
City' State Zip Telephone'
CONTRACTOR'S NAME/COMPANY�Lic. No. Classr—
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Contractor's Address Contractor's E-mail Address
CityF State 7 Zip �y� Telephoner
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS RIGHT PLAN CHECK NO. •2�1
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