HomeMy WebLinkAboutX2019-0896 - Permit ApplicationTp lnt rr Worksheet
Ob � 9 pp
Worksheet for Combo Building &Solar Permit A licat,�on
❑ Comm'I ❑ Residential City of Newport Beach - Building Division 3 l
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building [7 Grading ❑Drainage ,KElec -4 VMech Alum Cu Yd Cut= Cu Yd Filll
Project Address (Not mailing address)
❑ Fire fK Liq ❑ Landslide
L
❑N/A Floor Suite No
Description of Work 2'
Use � Const Type Z7
l AANAA �� Ill �/� Oiy �%f0 �r 4 O # Stolrie�s®I # Units (if Res)®
9 i-C� Valuation
New/Add SF emo el SF Gara a/New/Add �-. .Material/Laa
bor ,
OWNER'S NAME Last
Owner's Address
City ALjI) StateI
First)
Owner's E-mail Address C95 DD
Zip Telephone
APPLICANT'S NAME Lash First �)
Applicant's Address Applicant's E-mail Address
06 v A6AZ-O/vE A Ui,` ✓4t :e_ 41 sbc o Z1
City S State Zip Telephone
ARCHITECT/DESIGNER'S NAME Last %-A First
Ar ec Designer's Address
S ilc /4,S 4?;,l
Cit � State
ENGINEER'S NAME Last 1 /-4:vA,5r,
Engineer's Address
City Sta e
Lic. No.
Architect/Designer's E-mail Address
Zip Telephone
First lLic. No.F
Engineer's E-mail Address ef'
Zip J Telephone � _' _
CONTRACTOR'S NAME/COMPANY f j Lic No. ® Class
/NZ)Sd r 13"&-ak es
Contractors Address
G !oL Zt�/LG;t=
City r �� State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
Contractor's E-mail Address
SH � ct�fGix/L2y54 D ,C
Zip q Vc%Z( Telephon %/ / ;%
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
1141