HomeMy WebLinkAboutX2019-2447 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
F_ Comm'I j Residential City of Newport Beach - Building Division 1
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �aw�•'
f—Building F- i—Drainage F_Elec rMech
i Plum Cu YdCut r cuvdFir
Project Address (Not mailing address) F- Flood F_ Fire f—liq [—Landslide [_N/A Floor Suite No
Description of Work
Use Const Type
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# Stories.. # Units (if Res'
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V/i r
3 O
Valuation $.
New/Add SFF_ Remodel SF Garage/New/Add
Material/Labor
OWNER'S NAME Lash�(l First
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Owner's Address
Owner's E-mail Address
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City. _r lrra,�. y State G�l.�-
Zip c7�E,iv Telephone)
APPLICANT'S NAME Last/453�7
First CJs
Applicant's Address
Applicant's E-mail Address
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'�/7��N? TelephoneF�i.Fj
_.Zip
ARCHITECT/DESIGNER'S NAME Last
First LicNo.l--�__-�
Architect/Designer's Address
ArchitectlDesigner's E-mail Address
City State F_
Zip I Telephone��J
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ENGINEER'S NAME LastJ
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First 7 Lic. No. r'—
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Engineer's Address
Engineer's E-mail Address
/7L/ (e' 11. / ..4,41 VJ10
Cityvrl a • e... State G?
Zip C);�Ll!(✓ ;� Telephone 17J�()c�-<��_ JJ��
CONTRACTOR'S NAME/COMPANY �Lic.No. ,..� (I l -a ClassF ��: ,%.✓� J���,.a- G��. j Ire , i / �
Contractor's Address
Contractor's E-mail Address
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cityq) c =.,� �o-��✓...., �, State
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Zip r `%Ja '! Telephone
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
. PLAN CHECK FEES $