HomeMy WebLinkAboutX2019-2456 - Permit ApplicationWorksheet for Combo Building & Solar Kermit Application
F Comm'I j Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIMP (WRI IRNAITTOI
[-Building F -Grading F -Drainage FElec j-Mech
I-PlumCu Yd Cut Cu Yd Fill
Project Address (Not mailing address) 7_ Flood
F- Fire (-" Liq J_ Landslide f N/A Floor Suite No
Description of Work
Use I Const Type F_s
# Stories[ # Units (if Res)
(
Valuation $.
Material/Labor
-�
New/Add SF�—. Remodel SF —' Garage/New/Addy
OWNER'S NAME - Last �J - -�
GL� First
Owner's Address
Owner's E-mail Address
city .o-..t�' State ell . '
Zip F) %Z, Telephone—.
APPLICANT'S NAME Last J OXCS ,,
First EZf
Address
Applicant's E-mail Address
IAp�pliliicc7ant's
O / D
/
GI•'S.. J. 5:,:> om__:C�..Fs L.-`/ .:!say
City State (,,?/t . Zip_
1�Telephone qi)-,' jc t ir.r/�9cJJ.
ARCHITECT/DESIGNER'S NAME LastF
First F_Lic No, �----
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State F — Zip
I Telephone�`J
ENGINEER'S NAME. Last F
First Lic. NoE—,--7�'--.
Engineer's Address
Engineer's E-mail Address
I W Y i Arlo . °Y)/0 7 '.
City _%-a-. J y-.. .State G�. ZIp r�� Telephone V7,�(>^�i-
CONTRACTOR'S NAME/COMPANY Lic No. ��. Class
(� �-
Contractor's A—ddress
Contractor's E-mail Address
City ���.Y State n Zip "yap Telephone) (io, .t)
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X'f✓(Jt�t . 'U^I"`-�U
SETBACKS LEFT SETBACKS RIGHT
_
PLAN CHECK NO.
USE ZONE .DEVELOPMENT NO
- PLAN CHECK FEES $