HomeMy WebLinkAboutX2019-2441 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application O�gWPo
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F- Comm'I j Residential City of Newport Beach - Building Division n
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F- Building Grading I-Diainage r`Elec j -Meth
-Plum CuvdCut � cuvdFill
Project Address (Not mailing address) F- Flood F Fire F Liq i` Landslide [-N/A Floor Suite No
Description of Work
Use Const Type
# Stories',, # Units (if Res)7'
`4-
$
Material/Labor)
iValuation
New/Add SFF - Remodel SFF —' Garage/New/Add F_-
OWNER'S NAME Last First
Owne''r's Address
Owner's E-mail Address
t/ / /.
City State ��-...
-fl_'..'
Zip Telephoned—,
. v 1� _...
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APPLICANT'S NAME Last J�
First
Applicant's Address -
Applicant's E-mail Address
City State � v
Zip -'7` Telephone got < clef,- gye)�d
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ARCHITECT/DESIGNER'S NAME Last
FirstLic.No. I
Architect/Designer's Address
Architect/Designer's E-mail Address
City � State F__
Zip I TelephoneF—
ENGINEER'SNAME Last-
First G71}F� Lic.No.K,^7vj
Engineer's Address
Engineer's E-mail Address
r > VV IV, K,Ieil AVP e1,o
City /�— _ State ��+
Zip !� ��� ..Telephone/���)c�1}1 _
CONTRACTOR'S NAME/COMPANY —
O
r Lic.No.-;T//t Class) n
/E-mail
Contractor's Address
Contractor's Address
City '� L..) State :?
Zip r). e. _,,� Telephone) /r'ir,� (�, f`,Le — cl s(7
_.
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE .DEVELOPMENT NQ
. PLAN CHECK FEES $