HomeMy WebLinkAboutX2019-2453 - Permit ApplicationWorksheet for Combo Building & Solar hermit Application 9010Comm'I j Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F'Building FGrading r -Drainage i-Elec j—Mech r—PlumCu Yd Cut Cu Yd Filll
Project Address (Not mailing address) F Flood r` Fire F- Liq (° Landslide I" N/A Floor j Suite No
Description of Work
Use ConstType
# Stories #Units (if Res)'
$
Material/Labor ,j k.
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%Valuation
New/Add SFF — Remodel SFF — Garage/New/Add F_!
OWNER'S NAME - Last.LLL First
Owner's Addresst
Owner's E-mail Address
City _.�L�.. �/ State C.�-
1. Grt
Zig. .. Telephone
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APPLICANT'S NAME Last_
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First �
ApSplilicanni's Address
City State . (I �jEE s, .
Applicant's E-mail Address /
Zip f Telephone (tJ o ;) c� t(c(.- vjgc)
73-c,
ARCHITECT/DESIGNER'S NAME Last
First Lic.No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State �+
Zip I . TelephoneF--
ENGINEER'S NAME Last
at
First Li c.No.�C•_.270,,5"
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Engineer's Address
Engineer's E-mail Address "
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city ,��,j�. State - ? _
Zip t}2 k; � Telephone�7/�)c)<3-7_ /%�✓r'
CONTRACTOR'S NAME/COMPANYLic. No. c .
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Contractor's Address
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City �' ,.. �Vy _. .r/. State !,
Contractor's E-mail Address
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Zip t � .r.. Telephone e
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 7 4,�>3
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE .DEVELOPMENT NO
PLAN CHECK FEES $