HomeMy WebLinkAboutX2019-3109 - Permit ApplicationPrint FormWorksheet for Combo Building & Solar Permit Application
omm'I F_ Residential City of Newport Beach - Building Division A Z
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building j- Grading
r:Drainage tec Mech Plum
cuvdcutr—
cuvdFill
I
Proje/ct Address (Not mailing address) F Flo^o�drq ( Fire j- Liq
F_ Landsli/de
I -N/A Floor Suite No
4jp
of Work
1, 4tu�'fi� P'i
New/Add SFr RemodelSF
OWNER'S NAME Last � "-t"JTI" ,
Use I/n-air Const Type
'ZL 41 U fil t)
# Storiesrta # Units (if Res)r—
Valuation5
Garage/New/Addr�— Material/La
L -x /��l%�G
u - F;rst
Owner's Address Owner's E-mail Address
III (fit) 61yi jkj IJ p F -
Citi I G �2 �����!! State. ..,p �j •L �'' ,l Te
APPLICANT'S NAME Last
I
Appll .ants Address
17
r ,
City � �( j?lhlV �}�. State
P,Rn3.TLCUDESIGNER'SNAME Last I1G'R�-G7r't
A, chit- ct/Dasignar`s Address
lop, U
City Iy rwVF&r � `i �/-1'1 State F.. .
ENGINEER'S NAME Last
Engineer's Address
Zip
)hone) l'I el, "ZO -.. 2A<C'r
First
Applicant's E-mail Address -
J —i�'�• /J�
Telephoner L, 2 'v -1 _�,l - %i' ;i -v
G
First f> `u Lic. No. PG
A rcintect/Designer's E` -mail Address - —
Telephone
F�I
First
Engineer's F -mail Address
' Lic
City State r-- Zip T elephoneF
CONTRACTOR'S NAMEICOMPANY ����j�I ,`" i�(�' ij�./'�/1✓j j� Lic No. j(,i Ctassl V'Z
i
Contractor's Address Contractor's E-mail Address
�Q �r�✓(UV, cF;vi� )z (its ' _ � _ _ _
City 1-- t/1 Ni> _ State F cA Zia 0417- Pte Telephone Ci N C1 -(fir
SETBACKS REAR
SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
USE ZONE
DEVELOPMENT NO
PERMIT NO. _X A� e �
PLAN CHECK NO. op/1i
PLAN CHECK FEES $