HomeMy WebLinkAboutX2019-2588 - Permit ApplicationPrint Form Worksheet for Combo Build ing & Solar Permit A lication o�EW�ra
F Comm"
F/Residential City of Newport Beach - Building Division X/��J�J �4 z
NOTE' PLAN CHECK FEES DUE AT TIME OF SUBfMITICC V
Building F_ Grading F Drainage j-Elec r Mech F: Plum Cu Yd cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood r- Fire r- Liq r Landslide rN/A Floor Suite No
Description of Work
Use F—Const Type F_
S
#Stories #Units (if Res)
Valuation $
Material/Labor
New/Add SFF Remodel SF�— Garage/New/Add �-
OWNER'S NAME Last
�lQ�rl �/ First /"I, �p
Owner's Address
Owner's E-mail Address
City �—
State F_ zip F_' - TelephoneF�
APPLICANT'S NAME Last
r6ss First SCG�k-
Applicant's Address
Applicant's E-mail Address
30,30 gull rta� 5,A
City n„p�
1�a Scha PS Iry;1c1e�. c�
State Zip 1df� Telephone e1[.l�.e. `7 em?,)3- L � u
W [ �3- ►� 3
ARCHITECT/DESIGNER'S NAME
Last First F Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
State F Zip TelephoneF�
ENGINEER'S NAME Last
R U r �� First Lic. No.F-
lJ 1 r`�
n
Eingineer's E-mail Address
Ic�� �C/��t�CJS r.
City �(j 5\,f, �.�
'�a<i Orha �AU�Gh'Urke_��w�
State I- v— Zip Telephones 7 ._6 y j _ 0j_) C
CONTRACTOR'S NAME/COMPANY
�. I me� h e Lic. No. �� l� Claass
�l
Contractor's Address
Contractor's E-mail Address
Fail?u 5�� 5�
City��<, ,�.,1��
�c-c 6 bctWcr-,. ,.
State ('� Zip e' jQ) Telephone 6-
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO,
PLAN CHECK NO.
PLAN CHECK FEES $