HomeMy WebLinkAboutX2019-3482 - Permit Applicationr_.
LPrint Form Worksheet for Combo Building &Solar Permit Application
F Comm" Residential City of Newport Beach - Building Division /.97q.,ZO1$
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL VP,,) e0_ 2Uf
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Project Address (Not mailing address) F7, Flood F Fire i Liq [7.Landslide ❑N/A Floor SSS Suite No
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Description
of Work
New/Add SF L// Remodel SFr Garage/New/Add
OWNER'S NAME Last
Owner's Address
City �r State
APPLICANT'S NAME Last
First
Use Const Type VW-
# Stories5;1_�# Units (if Res)F
Valuation yL r
Material/Lab �
Owner's E-mail Address
i
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Zip Telephoned,
First
Applicant's Address `` Applicant's E-mail Address
City State Zip Telephone
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ARCHITECT/DESIGNER'S NAME �—
Last -�Firs t.l I Lic. No.
Architect/Designer's Address
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City State
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Architect/Designer's E-mail Address
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Zip Telephone
NAME Last -i Of-f1�(----..._....----- First -� t277 Lic.No. �W_W t
Engineer's Address �i�a .rte �f Engineer's E-mail Address
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City - �,� - {�((,t4ir7 J State Zip FI ] Telephone��-'7.7�3
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CONTRACTOR'S NAME/COMPANY Lic. Class
No. `7f�7t_
Contractor's Address >> Contractor's E-mail Address
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City/ --- State %% Zip �_7_l Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. X's"n • i5'-
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. V Q 140
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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