HomeMy WebLinkAboutX2019-4042 - Permit Application�X,20�q - `lo l—I 2
Print Form Worksheet for Combo Building & Solar Permit Application
F Comm'] KResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_ Grading F -Drainage rElec rMech rPlum CuvdCut F_ CuvdFill
Project Address (Not mailing address) Cv Flood F- Fire F_ LiqF_ Landslide f N/A Floor Suite No
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F F_
Description of Work
Use Const Type FVf
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# Stories # Units (if Res)
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New/Add SF —5,1— Remodel SF F—
luation
Garage/New/Add 1 3 Material/La or
OWNER'S NAME Last _WJ�U2�ipl
First F^L��
Owner's Address
Owner's E-mail Address
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City _Af&,),�1,yf,i' tat _ ... State _.. �_.: Zip 9'_(3Z7_ Telephone F711 H qIS_�454..
APPLICANT'S NAME Last First
Applicant's Address
Applicant's E-mail Address
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Zip "17i�15l Telephone j�.`�
ARCHITECT/DESIGNER'S NAME Last �V��
First � � Lic. No.F_(,M\
Architect/Designer's Address
Architect/Designer's E-mail Address -
City State F
Zip Telephone��
ENGINEER'S NAME Last " ��—
First Lic No.F_
Engineer's Address
Engineer's E-mail Address
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City StatesZip
r�1�5 Telephone.I_ILY
CONTRACTOR'S NAMEKOMPANY
Lic No. Classs�
Contractor's Address
Contractor's E-mail Address
City � State �—
Zip �� Telephone)_
SETBACKS REAR SETBACKS FRONT
PERMIT NO.06, ,
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N0. 44- j
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ 1