HomeMy WebLinkAboutX2019-2604 - Permit ApplicationPrint Form WorJ"et for Combo Building & Solar Permit Application o E°°Rrm
j— Comm'I j`Residential \) City of Newport Beach - Building Division
NOTE, PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
—Building Grading fDrainage F- Elec r Mech r Plum Cu vd CultCu Yd Fill
Project Address (Not mailing address) F_ Flood r- Fire r— Liq ,fcLndslicle r_N/A Floor Suite No
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Description of Work
Use ConstType
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# StoriCC
� # Units (if Res)[_
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New/Add SF S Remodel SF Gara a/New/AddF—
Valuation a
Material/Labor 500 O ^
OWNER'S NAME Last f
--.-....-� First
Owner's Address
Owner's E-mail Address
City F
State F Zip F— TelephoneF—
APPLICANT'S NAME Last
14j 7-LZ First I C. t�
Applicant's Address
Applicant's E-mail Address
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Sc t Ti7 1—AR c( (2, RAc, BEU., FtE-1
Ciiy - LuC,-C1H
State C> Zip �Z�� Telephone ! 4 343 0303
ARCHITECT/DESIGNER'S NAME
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Last 0 �`ZCO First �� Lic. No. C. (� 64S
Architect/Designer's Address
Architect/Designers E-mail Address
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City CUSTi M
State � , Zip CC'Z,'z � Telephone (k4..3 q3 03o3
ENGINEER'S NAME Last �— First Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City I
State F_ Zip F_ Telephone[ —
CONTRACTOR'S NAME/COMPANY
Lic IN �Flr/1 �./ VU Class
VV v/
Contractors Address
Contractor's E-mail Address
City
� State F— Zip �� Telephoned
SETBACKS REAR
SETBACKS FRONT PERMIT NO. L
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $