HomeMy WebLinkAboutM2019-0074 - Permit ApplicationPrint Form Worksheet for Combo Building&Solar rt1�� naw
I•fiitApplication
Comm'I r Residential City of Newport Beach - Building DivisionINOTE: PLAN CHFCIc PFFS nI I❑ AT Tmno , o. �.,..�-,-r.
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j-Building F_ Grading
FDrainage F_ Elec r Mech F- Plum F F_
Cu Yd CutCu Yd Fill
Project Address (Not mailing address) 7 Flood F" Fire f- Liq r Landslide FN/A Floor Suite No
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Description of Work
Use ConstTypeF_
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# Stories #Units (if Res)
Valuation $
Material/Labor
New/Add SFF_
Remodel SF �� Garage/New/Add ��
OWNER'S NAME
Last TF-1 C q LI Lj +,i i,q L.I:Bo N i72�st 1 45 "r Z�
Owner's Address
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Owner's E-mail Address
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City ( A
State G4 I
ZiP y` = s Telephone
APPLICANT'S NAME
Last W. 7, j�) V a4NT IW First C 'ZAii()-1 J -tpj-
Applicant's Address
Applicant's E-mail Address
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City S i C.nl.9"c- I-% I« __._ State G A Zip q" r 5; Telephone S
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ARCHITECT/DESIGNER'S NAME Last�`
First �� Lic. No.
I"�—
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
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City 1—
State F_ ZIP �� TelephoneF_�
ENGINEER'S NAME
Last F First F_ Lic No.F_
Engineer's Address`
Engineer's E-mail Address
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City 1
State �— Zip �— Telephoned`
CONTRACTOR'S NAME/COMPANY Lic. No. 44j_ ��lassF
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Contractor's Address ��,iL Cn.✓ 'f87S`jD
Contractor's E-mail Address
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City ".' '
State C- q ZIP `- - ' " Tele han -. �.
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SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT PERMIT NO, v
PLAN
SETBACKS RIGHTyoff
CHECK NO. �O
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $