HomeMy WebLinkAboutX2019-3912 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o4 EWE,
( Comm]Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) Flood r- Fire r - Liq Landslide `_N/A Floor Suite No
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Description of Work
Use F_ Const Type F_
9#Stories #Units (if Res)[
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Valuation $
Material/Labor �p
New/Add SFRemodel SF F— Garage/New/Add �—
OWNER'S NAME Last %� lLC First
Owner's Address Owner's E-mail Address
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City I /�62„� � � r State Zip j21 &(,, Telephone
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APPLICANT'S NAME Last 6;Z1ASy0 First
Applicant's Applicant's E-mail Address
/Address
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Citylin% G✓i�t.s'HG.a+ State Zip-fi/7_5✓ Telephone 7s/I155—
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ARCHITECT/DESIGNER'S NAME Last First I Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City State F_ Zip TelephoneF_
ENGINEER'S NAME Last First Sd{ Lic. No.> tab 7
Engineer's Address Engineer's E-mail Address
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City State �� Zip yQl �(•� i Telephone
CONTRACTOR'S NAME/COMPANY \Lic No. K/ b�k Class
Contractor's Address Contractor's E-mail Address
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City •^� �' � � � State— Zip / �Telephone (7-, I �- z ya4o
SETBACKS REAR SETBACKS FRONT PERMIT NO. X Zo I �{
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $