HomeMy WebLinkAboutX2019-2444 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application °�EWa° e
F" Comm'I j .Residential City of Newport Beach Building Division o .oa � .�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL a"
f -Building F- Grading I -Drainage (-Elec Mach ( Plum euYdCut CuvdFill
Project Address (blot mailing address) F Flood F_ Fire I- Liq F Landslide F_N/A Floor Suite No
Description of Work
Use F ConstType
# Storiesr—# Units (if Res)F-' -
a.4/,�:�.Y� �r%l. -, ? ,
'Valuation
$
New/Add SFr- Remodel SFr--� Garage/New/Add F-,1
Material/Labor
OWNER'S NAME Last C'i `L(J First
Owner's E-mail Address
Owner's Address,{.
City i. /V, ✓..c</ .( .Caeh _ StateL �-... Zip I"-) k,(vU Telephone�v
APPLICANT'S NAME Last ���� First
Applicant's Address Applicant's E-mail Address
State Zip (% 7 Telephone (90:,
City K.�.�cG� l.Nc.ivna
j,,� ..5T
ARCHITECT/DESIGNER'S NAME Last First Lic. No. ��'
1
Architect/Designer's Address Architect/Designer's E-mail Address
city�State F— Zip I Telephonew
ENGINEER'S NAME Last First Lic. No.K-- -; lx r70-1-..
Engineer's Address Engineer's E-mail Address
r, klr A 40/o
�._...-..,State G; - Zip r
City � Telephone
_ �.� !2ki,;,
<� ��
CONTRACTOR'S NAME/COMPANY Lic. No.c`( Class
vs' 1 ✓e nz � fir;., $(L B
Contractor's Address - Contractor's E-mail Address
City =�r..i!:gi Stated Zip F/%zrzl .Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. )(�lq
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO. PLAN CHECK FEES $