HomeMy WebLinkAboutX2019-4060 - Permit Applicationf QA-f-w4
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Print Form Worksheet for Combo Building & Solar Perm%A, lication
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City of Newport Beach - Building Division
F Comm'11 Residential _�Ouo
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
011k.
F-1-61L,cl I d i n g F_ Grading F—Drainage F_. Elec F_ Mech
F- Plum Cu Yd Cut F;7 Cu Yd Fill F
Prrojc_-c_t Address (Not ma[illing address) r7 Flood
Fire F- Liq I- Landslide F_NIA Floor Suite No
cy 4-C Iw aw,
Description of Wor"�mvmelvxl r)f--
Use Const Type F
# StoriesT # Units (if Res)F—
A I -
A
'7—
A Lp-
67 Tt
Valuation $
Mmerial/Lab or
Remodel SFl-.-, �arage/New/Adfd
New/Add SF1 V10 Q-ex� A,
OWNER'S NAME Last First 06NA4— C7� -,—A-" q__4 _> DA-
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Owner's Address
Owner's E-mail Address
Q` Z, �0 Cv
.51 -IT
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City —7,0 State
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Zip Telepho6_jr-p
APPLICANT'S NAM Last
Applicant's Addres
Applicant's E-mail Address
At_,
City State Zip 11j_ Telepho
F�
ARCHITECT/DESIGNEWS NAME Last FirstF .7 4, Lic. No.
Arch itect/Designer's Address
Architect/Designer's E-mail Address
15, 6e F75-
State Zip Telepho44o'l.-- 41!�S-D
City C. �Z
ENGINEER'S NAME Last
First LIC.
Engineer's Address C-(f 6-r,
Engineer's E-mail Address
1 6 Vo
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City State Zip �Z&Z5_ Telephon _),5 VS
CONTRACTOR'S NAME/COMPANY
Lic. No. f Class
Contractor's Address
Contractor's E-mail Address
City State Zip Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $