HomeMy WebLinkAboutX2019-2295 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application oeH°°are
rF Comm'I f Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
X-Building F_ Grading FDrainage F_ Elec F_ Mech
j Plum Cu vd Cut Cu Yd Fill FS
Project Address (Not mailing address) F-
F Fire F_ Liq j- Landslide I_N/A Floor Suite No
�Il
t 13rY�,D l7R, lUewom?r [1kH, CA
946o
Description ff Work
Use I— Const Type
N4)zD A )mPstrk'Mou6-
# Stories? # Units (if Res)[_
New/Add SFRemodel SF Garage/New/Add
Valuation $
Material/Labor 301ovo
OWNER'S NAME Last �Ut+�T
First Ate%
Owner's Address
Owner's E-mail Address
__
City '. AlC'�f�7,r 13E>'1ut State (rA
l
7aa
�_
Zip )7 Telephone �qq- 4w - 3,t10
APPLICANT'S NAME Last '�
First AST
Applicant's Address
Applicant's E-mail Address
01 Glererar �AcG
Au>clg e �cr�zwc�sr.ra,�t -
City tJ'aAf T$L?17Ci1 State
Zip q�160 TelephoneCjycj_7X1_ya31
ARCHITECT/DESIGNER'S NAME Last F_
First F_ Lic. No.
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
City �— State F
Zip �- Telephoned
ENGINEER'S NAME Last �� �
First Lic. No. 6�Z13
Engineer's Address
Engineer's E-mail Address
tim 1 49 c A.k ))j
�ftLPsLnZ75or J� G�R1�G3T. 4"
1A
City ��vi , >T StateIL
Zip 7d460 Telephone ytq 00- 9�J5%
CONTRACTOR'S NAME/COMPANY
Lic No. F ClassF
(Contractor's Address
Contractor's E-mail Address
City F State F__
Zip Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X �( - Z�
SETBACKS LEFT SETBACKS RIGHT
C��`1
PLAN CHECK NO. I�j 1 7 - ZC \
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ 0 . Z