HomeMy WebLinkAboutX2019-0259 - Permit ApplicationA Gul l - U GAJ `)
PofltF :� Worksheet for Combo Building & Solar Permit Ap lication oF�E°
Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK `FEES DUE AT TIME OF SUBMITTAL `+u.o.+'
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Project Address (blot mailing address) C Flood C, Fire [ Liq C Landslide Floor Suite No
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Description of Work ✓
Use Const Type
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# Stories #Units (if Res)
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Valuation $ cc
Material/Labor
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New/Add SFLfKY, Remodel S J arge/New/Add
OWNER'S NAME LastfF!c`,. First
Owner's Address Owner's E-mail Address -
City (i!� C. i � e r '-. � '0' StateG-. .Zip y .'+F.� Telephone�`e`�r ' ".4 .. 'ger �„i Q
APPLICANT'S NAME Last First
Applicant's Address 2;l A ?�- CR cl W- 'V{01 Applicant's E-mail Address
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City I (?&,w Lk -S State Zip ;Fj TelephoneEe?K_
ARCHITECT/DESIGNER'S NAME Last w First
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ArchitectlDesigner's Address Architect/Designer's E-mail Address
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Lic. No.
ENGINEER'S NAME Last ll?'°m First... ���'
Engineer's Address + Engineers E-mail
lAAddress
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CONTRACTOR'S NAME/COMPANY / / /�LiC. No.h Class
Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONTS PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $