HomeMy WebLinkAboutX2019-0556 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
F- Comm'[ F- Residential k"TE: of nni r.NF:r.K FEES DUE AT TIME OF SUBMITTAL
Building F Grading r"Drainage vF- Elec F Mech r' Plum Cu Yd Cut t— Cu Yd Fill F
Project Address (Not mailing address) C Flood r- Fire F- Liq C- Landslide [N/A Floor Suite No
Description of Work
Use F Const Type
# StoriesFT # Units (if Res)F_
Valuation$ p BOO
Material/Labor 1
I
New/AddSFF Remodel SFF Garage/New/Add
OWNER'S NAME Last � .Ivr; WpM (. t4I LS r First
Owner's Address Owner's E-mail Address
City N � State �- Zip `f 1GG3 Telephone I(f —Q�
APPLICANT'S NAME Last SM i Tt 4 First (-Lv&uS
Applicants Address Applicant's E-mail Address
111 -till- (:A Mos o ry t OT 1
City J� N State F Cf)r- Zip Q Telephone -77( It S3 I 1
ARCHITECT/DESIGNER'S NAME Last First F— Lic. No. F—
Architect/Designers Address Architect/Designers E-mail Address
—
City �— State �— Zip �— Telephone
NAME First FQ 1 A W6, Lic. NoT
ENGINEER'S Last C)
Engineer's Address Engineer's E-mail Address
15; -LO VLCL0oVL14oI.Gt9w 4- 4.5
City S(�N i d_ (} Al 1A- State I C. -A zip'9.L7 os- Telephone 714 662 PS'70
CONTRACTOR'S NAME/COMPANY Lic. No. 637440 Classr—
tvbJS S/N.'StY LIJNSt
Contractors Address Contractor's E-mail Address
^
city SAIt%�� tt-c�1/�- ._ State �C�y ZIP �1�jOS Telephone 714 S-1 le I_I7I
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO. /\ `iA�� • �'J �f�
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $