HomeMy WebLinkAboutX2019-0963 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application
Comm'I F_ Residential r\ N\City of Newport Beach - Building Division
NOTE
' \ PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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cription of Work
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W MIACK'D NAME
Last 113, rn p S on
Owner's Address i
Vle. FlDre(lce
City P_ P r c-+' t State
APPLICANT'S NAME Last We ndreZ
Applicant's Address
City S C1, «_ State I Z
ARCHITECT/DESIGNER'S NAME
Architect/Designer's Address
Cu Yd Cut
F Landslide
Cu Yd Fill
F—N/A Floor
Suite No
Use r` Const Type ltjs
#Stories #Units(ifRes)r—
jam— Valuation $
I Material/Labor Q
First I Ta k n
Owner's E-mail Address
ZIP C/j & (f, '3 Telephonef —
First I Ad GJ ( e_-,
Applicant's E-mail Address
Zip °CZ'% _03' Telephone 3(or_—__`
Last l
First
�y-\ Lic. No.
i
Architect/Designer's E-mail Address 9
City I State s -Zip F_ Telephone
ENGINEER'S NAME Last ^
y -
Engineer's Address First '`+ 0 JV
Engineer's E-mail Address
City State
ZIP F_ Telephoner
CONTRACTOR'S NAME/COMPANY
Contractor's Address
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City
SETBACKS REAR
SETBACKS LEFT
USEZONE
Lic.
S C Lic. No. 68 Oi
Contractor's E-mail Address
State cQ Zip �z— 15- Telephones
SETBACKS FRONT PERMIT NO.}(�/�11
SETBACKS RIGHT PLAN CHECK NO.
DEVELOPMENT NO70
PLAN CHECK FEES $
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