HomeMy WebLinkAboutX2019-3663 - Permit ApplicationP�mt Form Worksheet for Combo Building & Solar Permit Application sm
F Comm'I F Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
IC-euilding j Grading rDrainage F_Elec r Mech F—plumCuvdCut F CuYdFill r
Project Address (Not mailing address) F_ Flood F_ Fire F Liq F' Landslide [_N/A Floor Suite No
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of Work
10,5 4x Rw A
New/Add SF F
OWNER'S NAME
Owner's Address
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city F�
GF'
Remodel SF F—
Last
APPLICANT'S NAME Last
Applicant's Address
City
ARCHITECT/DESIGNER'S NAME
Architect/Designer's Address
City
ENGINEER'S NAME Last
Engineer's Address
City
Use ConstType Im
# StoriesFF # Units (if Res)
W A-VIAV o
Valuation
Garage/New/Add F_ Material/Labor l/wc.JU
First I ?r
Owner's E-mail Address
State Zip — _ Telephone Fkal atd1._sz>gA
First I V- F\
Applicant's E-mail Address
State �— Zip Telephonel- , 6% 151"
Last F� First Lic. NoF—
Architect/Designer's E-mail Address
State W Zip ��. Telephone[
First I Lic. No.F—
Engineer's E-mail Address
State r— Zip �� Telephone[_
CONTRACTOR'S NAME/COMPANY --- c No.
/i<4 1� C" 2 t Li/� Klass
Contractor's Address Contractor's E-mail Address
CityState/- Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. 01-ol r—
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. a91 ')^a-v C�
USE ZONE DEVELOPMENT NO IQ-L.OI I3 PLAN CHECK FEES $
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