HomeMy WebLinkAboutX2019-3910 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application OWN,
F_ Comm'I j- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
v
F-Building (— Grading r"Drainage r Elec Mech r Plum CuYdCut F CuYdFill F
Project Address (Not mailing add)ress/) F_ Floodr Fire _ Liq F_ Landslide F_N/AFloor Suite No
II
l
Description of Work
Use Const Type
# Stories #Units (if Res)
Valuation $
Material/Labor K
New/Add SF�� Remodel SFF
Garage/New/Add F_
OWNER'S NAME Last /l
C1�y
First
Owner's Address /
Owner's E-mail Address
�� ,�
SSLr......._.-._. ,., � Cam" J7o-/ �/_
City State �—
Zip N i TelephoneF_
APPLICANT'S NAME Last /�e.ssa
First(��''S
Applicant's Address
Applicant's E-mail Address
7 `
City 14.�/,..'c State
ZipTelephone
ARCHITECT/DESIGNER'S NAME Last F
First F— Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State
Zip �— TelephoneF__
ENGINEER'S NAME Last
First% �,;:.� Lic No.9
Engineer's Address
Engineer's E-mail Address
K fine _ 410/
City �State W
/
Zip �� Telephone��
926L7 �7i)437—//y5
CONTRACTOR'S NAME/COMPANY S - - Lic No. y/ ��� Class
/-�a-.�
Contractor's Address
Contractor's E-mail Address
% `?SG' /
City 1Lx State e
Zip /7_5 Telephone f/TS/)
SETBACKS REAR SETBACKS FRONT
PERMIT NO. XZ01Y �-
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $