HomeMy WebLinkAboutX2019-2082 - Permit ApplicationPrint Form '
F_ Comm'I #% Residential
ret for Combo Building & Solar Permit Application
1 City of Newport Beach - Building Division 782009 •208,2
/ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL /$17.2019
Building r Grading �' Drainage 76}1.,EIec AMech 0 Plum Cu Yd Cut F' Cu Yd Fill
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Project Address (Not mailing address) F Floo ire F_ Liq (' Landslide rN/A Floor S\L
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Description of Work
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Use ! �nJ Const Type
# Stories # Units (if Res)`,
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New/Add SFI � Remodel SF J�(J
Garage/New/Add ',
Valuation $ '/�
Material/LaborYV���
OWNER'S NAME Last-TSI�i� First..�A��....
Owner's Address
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Owner's E-mail Address
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City lv �/%�J��i Bi /! State ��y.
Zi ,z4i�Telephone P�7Y9
APPLICANT'S NAME Last
Firsts/c
Applicant's Address
Applicant's E-mail Address
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City //� ✓/( C V State 4�
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` Zip ,s-/ TelephoneFW ?,K/ ✓/�/..
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F
Zip F Telephoner -
ENGINEER'S NAME Last
First �.'. Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City r.� State(-----
Zip Telephone�—
CONTRACTOR'S NAME/COMPANY ✓ l/ 1 �. 1 Lic. No. ,11,V Class/
Contractor's Address
Con ractor's E-mail Address
City �� .. State CJ`��.
Zip ✓ZrT Telephone ✓ ��(� �._. �i;
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK
PLAN CHECK FEES $