HomeMy WebLinkAboutX2019-1686 - Permit ApplicationPrint Form Worksheet for Combt Bui'ding & Solar Permit Application " °^>e
F- Comm'I ( Residential City of Newport Beach - Building Division
NOyE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ��oar'
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Project Address (Not mailing a dress) lood
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Description of Work
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Use ConstType
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# Stori s #Units (if s)�
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Valuation $
Material/Labor 3J V� 000
New/Add SF Remodel SF y Garage/New/Add jvCt
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OWNER'S NAME Last `� Pr 2 2E (/
First ( C K N
Owner's Address
Owners E-mail Address
930 \)(A L.(na NO&O
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City Pew D&T 2,4L(n State (f/}
Zip R7_66, j Telephone `I-i(lq-
APPLICANT'S NAME Last
First I 1 C
Applicant's Address
Applicant's E-mail Address
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City I }J WPOAT State
Zip G/Zlpb 3 Telephone 9 4q- iv �'�' $S S 0
ARCHITECT/DESIGNER'S NAME Last First-'�'r"O �
��(��.E� AJ� Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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City I D*4 ���� State C%�
Zip
< �o-Z-7 Telephone W? 76Z[Z6
ENGINEER'S NAME Last ��
First Lic. No. ,30407
Engineer's Address
Engineer's E-mail Address
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City ,56-Y,Td 1,%V- State
Zip yZ�7al Telephone
CONTRACTOR'S NAME/COMPANY
Lic No. ClassF
Contractor's Address
Contractor's E-mail Address
City �Q�,,.)1(1T �e{{ State
Zip�}�'SgS�r
SETBACKS REAR l"J SETBACKS FRONT -' PERMIT NO. )(2,00 — t bb b
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N0. I Zp I - •I.JI �7
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $