HomeMy WebLinkAboutX2019-1772 - Permit Applicationi Print Form I Worksheet for Combo Building & Solar Permit A 9131acation
j Comm'I ( Residential City of Newport Beach - Building DivisionlF-tul •. �,1 Z
NOTE: PLAN CHECK FEES DUE AT TIME OF SUB TTAL
F Building Grading FDrainage Elec ®.., Meclh
Plum c cutF Cu vd Fin I
Project Address (Not mailing address) I_ Flood F_ Fire F_ Lic
dslide I_N/A Floor Suite No
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Description of Work 7
UseMuconst Ty �r_ # Stories[— # Units (if Res)F—
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New/Add SF _., R emodel SF valuation, $ Garage/New/Add Material/Labe
OWNER'S NAME Last I (�T. First
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Owner's Address
Owner's E-mail Address
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City t L-r_1/ZsLM State F, Zip TelephoneFT 14 . `S 1q t
APPLICANT'S NAME Last _... ,4'JZ_T'Firs l� t
Applicant's Address Applicant's E-mail Address
City �DSr� I�� --} State[
c Zip G� Z� � 1 Telephone e � � ¢ -� ✓L�,�
ARCHITECT/DESIGNER'S NAME
Last Lic. No.� �•��
Architect/Designer's Address Arch itect/Designer's E-mail Address
City I State Zip [_ Telephone[ —
ENGINEER'S NAME Last
(.J�LLJ�L13 First SC-a�_ Lic.
Engineer's Address
City L� State Z,�
CONTRACTOR'S NAME/COMPANY
Engineer's E-mail Address
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Zip �"ZQO 7 Telephone cl�
Lic. No. �ir� I �1 Class
Contractor's Address
City I � rlV, k, &\,
State Lw
SETBACKS REAR (��ETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE ( DEVELOPMENT NO
Contractor's E-mail Address
Zip `1Z�?C�e1 Telephone o�)Ci3 -�ZIZ
PERMIT NO,
PLAN CHECK NO. 1 _71C-2 >:
PLAN CHECK FEES $