HomeMy WebLinkAboutX2019-2172 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application D4, �°R n
s
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ""
PBuilding r Grading rDrainage �Elec MMech Plum cu Yd Cut Cu Yd FillF
roject Address (Not trailing address) r Flood r Fire r Liq r Landslide �N/A Floor Suite No
P
Description of Work Use y;.N�ryCon stType
# Stories�� it Units (if Res)
Valuation
/New/Add�JMaterial/LaNew/Add SFF Remodel SF Garage bor 119,aeo OWNER'S NAME Last '-f"� �y ��'✓i� �. First
Owner's Address Owners E-mail Address
(I I 1 Nrnia°v*1I/,qJ Piz
City '� �? ���Ni% State — Zip �F&L 1-' Telephone � �Gi; 'ZU _ - i6
APPLICANT'S NAME Last Vf a�-I•� (First W
Applicants Address Applicant's E-mail Address
City (/��/l%f State �� Zip �Z�yjkJ Telephone L����G����- Z��7�
ARCHITECT/DESIGNER'S NAME Last ��� t�.lr r �7 First �, 14L, Lic. No. 771 I 'i �I f�
Architect/Designer's Address - Architect/Designer's E-mail Address
City ��rPv�Gjz'r C>/aL(''i State C� Zip71 Telephone'"
ENGINEER'S NAME Last First �— Lic. No.
Engineer's Address Engineers E-mail Address
City .. State �- Zip F Telephoned
CONTRACTOR'S NAME/COMPANY. 'bl� Lic No.F— ClassF
Contractors Address Contractor's E-mail Address
City State �— Zip F Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO. L-7`-7- Zr 7 1
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
�y
�- A —Sf' 1 L \ S