HomeMy WebLinkAboutX2019-4132 - Permit Application7�10 UI3Z
Print Form Worksheet for Combo Building & Solar Permit Application
X Comm'l F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F- Grading F -Drainage FX Elec PSMech A Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood X Fire F- Liq j- Landslide I -N/A Floor Suite No
Description of Work
Use Const Type �(Pj
# Stories #Units (if Res)
eual Orem ft@ of.
rrxt9'TI L)G u QE
New/Add SF Remodel SF Garage/New/Add
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Valuation s %Q7�
Material/Labor
OWNER'S NAME Last *AO-rofr- QE;�1l,Cy tNU6Q(', First
Owner's Address
Owner's E-mail Address
Z PAe1:. ?�AZD• r yu1TE'?00
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city - (ti�1101: _. State -C+/S.
Zip 9261V' -, Telephone 949' 417' If%
APPLICANT'S NAME Last blvd
i First
Applicant's Address
Applicant's E-mail Address
K921 lPtvr.4R cert'. * 1bQ
ato W e Ava. �s vl�, .c�of1
City tJEWPO .-_or E ppfl.. __--, State
zip[ p _Iuiba Telephone '(l�.'���'ti7
ARCHITECT/DESIGNER'S NAME Last O) r, ) __.' First' vk Lic. No.
V" lllddress t
Architect/Designer's Address
Architect/Designer's EE-mailAddress
City StateZip
Telephone
ENGINEER'S NAME Last - (� t C , First -/ `J Lic. No. u
`� \
Engineer's Address 04
Engineer's E-mail Address
�._
City I _ State
Zip Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. Class F_
Contractor's Address
Contractor's E-mail Address
City �— ,,. State �
Zip F_ Telephoner
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. C�
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $