HomeMy WebLinkAboutX2019-2201 - Permit ApplicationWorksheet for Combo Building&Solar Permit Application
:ial City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
I Grading F -Drainage J_ ElecF Mech r`
plum Cu Yd cut
it Address (Not mailing address) F_ Flood F Fire F_ Liq r- Landslide [-N/A Floor Suite No
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Cu Yd Fill
Des-ccrription of Work
J %�vro ira�2 (LloYty tz:t �A y` Use I— ConstTypeF
oFFdC.F_fi #Stories[ # Units (if Res)F_
New/Add SFF � Remodel SF � Valuation a
Garage/New/Add �� Material/Labor
OWNER'S NAME
Owner's Address Last 7t 1j
(?OY'riS V, _ _ First
_
I L/ L ,C,.Et1QLifE o Owner's E-mail Address
. �1�
city �epkzc-pr; 94, C a;- � State -
ZIP?C-m`O Telephone 11h,57 it- f it
APPLICANTS NAME
..Last .w�t P Firstq. eF -
Applicant's Address - - -
rLt I Applicant's E-mail Address
City State..
Zip 20'tf� Telephonejiq,>
ARCHITECT/DESIGNER'S NAME
Last � First F� " t
Architect/Designer's Address Lic: No.—
Architect/Designer's E-mail Address
City ��
.State Zip F— Telephone��
ENGINEER'S NAME Last v
FirstLic. No.
Engineer's Address -
Engineer's E-mail Ad r s
City.
State Zip
F, TelephoneF��
CONTRACTOR'S NAME/COMPANY
Ai C13 , g33, a:se- Lic. No.1 6 (?Z 1;3 Class
Contractor's Address
dctbTT
� , - e Contractor's E-mail Address
L �-- S-'�nr�c
City >I �w�� Ij� � ��-���-�.riC���:'�,
4 State C IA Zip '?® Telephone
/y- 5-y e
SETBACKS REAR -- SETBACKS FRONT PERMIT NO. „
SETBACKS LEFT '�—
USE ZONE SETBACKS RIGHT PLAN CHECK NO. j5t. a
DEVELOPMENT NO
PLAN CHECK FEES $