HomeMy WebLinkAboutX2019-1088 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application �EWP°RT
City of Newport Beach - Building Division
Comm'I j Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL /� � log
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Building F Grading r—Drainage F_ Elec F_ Mech F- Plum cuYdCut CuYdFill
Project Address (Not mailing
address) F_ Flood [— Fire Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use Const Type
# Stories # Units (if Res)[
. /mow 0, " �,�
G�?u �o,n•-y L//J&
pp
Valuation $
New/Add SF� Remodel SF Garage/New/Add F�
Material/Labor
OWNER'S NAME Last
�G�/li First AU/N
Owner's Address
Owner's E-mail Address
/2/8 A�X, 3/&/ 4N-,.
City
State �,/� Zip Telephone
APPLICANT'S NAME Last
vos First
Applicant's Address
Applicant's E-mail Address
9 7c� . i�.�a,*v�
/�1�✓7G �Gnr y q/�gIl cc).v
City ��LG�GoWc�
State `l Zip ?07 � Telephone S - SCS -.S9S8
ARCHITECT/DESIGNER'S NAME
Last F First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State �� Zip [_ Telephone
ENGINEER'S NAME Last
First F _ Lic. No.F
Engineer's Address
Engineer's E-mail Address
F_
City �
State �� Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY
IV C Lic. No. Class
Contractor's Address
Contractor's E-mail Address
970! /oNA
41tl✓�,Rso✓1 rJ' ��M� i �. e
City � c ��
State c,� Zip 90 706 Telephone S6. S-05 - 7jg
SETBACKS REAR
SETBACKS FRONT CJ PERMIT NO. !✓\� ` O(
SETBACKS LEFT
SETBACKS RIGHT 1 PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $