HomeMy WebLinkAboutX2019-4041 - Permit ApplicationL.v Form Worksheet for Combo Building & Solar Permit Application MT.`Comm'I F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES r111F AT nnnF nr si:amm�e:
--Building Gr ding Drainage rElec rMech j Plum Cu vd Cut Cu vd FillIf
Flood If
Project ess (Not mailing address) F Flood C Fire Liq j Landslide FN/A Floor Suite No
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Description of Work
Use iy a ConstType Y
r r. \' i V N J ^`
n
# Stories j # Units (if Res)
Valuation $
Material/Labor'�'�
New/Add SF Remodel SF
Garage/New/Add F:9�
OWNER'S NAME Last
First�C�t
Owner's Address
Owner's E-mail Address
City t4J Evq(Jrii'j` OLP�_4 State Fe, Zip ; 1-,%,� Telephoner —
APPLICANT'S NAME
Last �J�i l
First +,�, 1
Applicant's Address
Applicant's E-mail Address
City p State
-
.. _ I / Ci j
Zip - n `- Telephone
ARCHITECT/DESIGNER'S NAME
Last �,l� ��
First `.1141 i (j Lic No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City State � �
' �� -,--7
Zip 7_U 7._. j Tele hone1 .�'
P j 00 �, 6
ENGINEER'S NAME Last
cJ (� fi (`J Lic No.�—_
First l '
Engineer's Address
Engineer's E-mail Address L-P uP S3
—�
City State / �
Zip �'r� Telephone 7 , ,r
CONTRACTOR'S NAME/COMPANY
r-20 K_}1d:e(LT
1� z ,.-� Lic. No. q
BR6—'KLC IDS"tc: Class .
Contractor's Address
Contractor's E-mail Address
City lr,;,z.�. State (�_ /_,
Zip S Telephone liz
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
'. Cr . PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $