HomeMy WebLinkAboutX2019-0588 - Permit ApplicationX2610l -- mn
Worksheet for Combo Building & Solar Permit Application
(_ Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
�rBuilding I_ Grading F-Drainage F Elec F Mech
F- Plum Cu Yd Cut V Cu Yd Fill F
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Project Address (Not mailing address) I_ Flood
F- Fire F_ Liq f Landslide F N/A Floor Suite No
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fjescription of Work._.v &-v ?( --_�_
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Use I Const Type F
# Stories y # Units (if Res)[
Valuation $
Material/Labor) (� 6
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New/Add S I Remodel SF Garage/New/Add ®
OWNER'S NAME Last �
First
Owner's Address
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Owner's E-mail Address
Cityj �� I LL State' �f
D�'f�
Zip - Telephone
APPLICANT'S NAME Last `/j%)�%�
I F —
First
Applicant's Address
Applicant's E-mail Address
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City21-
State ZipC�
Telephone
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ARCHITECT/DESIGNER'S NAME Last W
First Lic. No.
Architect/Designer'''--
s``Address (Arch itectt//DDesigner's E-mail Address
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I Gti�� ;�6 x, V 1t,4 r"v , 9-\f-:3
Ci 11 State -sj� zip Tele hone
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ENGINEER'S NAME Last �
First F_ Lic. No.F—
1Engineer's Address
Engineer's E-mail Address
/v
City State-� Zip-��
Telephone
CONTRACTOR'S NAME/COMPANY &D Z_ �99
% Lic. No. 1F6-/�- ClassF�
Contractor's Address
Contractor's E-mail Address
City / _ State Zip
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.-r� V
Telephone)
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ i