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HomeMy WebLinkAboutX2019-0875 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application (IM Comm'I f- Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL j`Building Grading F-Drainage (-Elec FMech F-Plum Cu Yd Cut Cu Yd Fill Address (Not address) [_ Flood F_ Fire r Liq r Landslide F_N/A Floor Suite No j�Project /m'�ailing I`" /1dY2�G�7�J-%C�I�'i `G/� % %�Ti/Ll,/iU� 2 � `l,'�� � 9*1 Description of Work ��� %�/` Use I—Const Type 1 / ? hG # Stories Z # nits (if Res)[ I�Valuation $ Material/Labor �0) New/Add SF�� Remodel SF� 13 f 67 Garage/New/Add F— OWNER'S NAME Last first Owner's Address 1R_V1i4_-6�_ j� Cp_ Owner's E-mail Address / p,� �. City . State <fr zipFfzFfL'3 Telephone?�19- APPLICANT'S NAME Last 75� First —/-,)I pVi14-J Applicant's Address Applicant's E-mail Address . / 7 cz Cd e � cam, �fJ l r �A City I OC fL� q, . 0 ✓>7 State C� Zip ZI Telephone U� 33 -ZJ43 0 ARCHITECT/DESIGNER'S NAME ��� Last ��LH First, Lic. No. C'ZTfjZZ Ar hi ecUDesi er s Adam �t 9 � ` cif i C . TT Arrchhitect/Designer'ss E-mail Address / p City /y%pti' /J r_ State C4 Zip Telephone 33g ZT-d3 ENGINEER'S NAME Last -- First Lic. No.7 Engineer's Address Engineer's E-mail Address City State �— Zip �— Telephone[� CONTRACTOR'S NAME/COMPANY �Lic. No. F 4 C ass Coontractor's Address J 4272�CJG Contractor's E-mail Address G , 4 (_ 13Scl�. City FZ- ffl, �: State C,�' Zip z 6 Z TelephoneF?/c7! ���-^ 11 / Dl� SETBACKSREAR SETBACKS FRONT PERMIT NO. SETBACKS LEFT fz SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $