HomeMy WebLinkAboutX2019-0344 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
mm'Idential _
NnTF- PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Ft -wilding F- Grading F-Drainage F Elec F- Mech
F- Plum Cu vd Cut Cu Yd Fill F
Project Address (Not mailing address) J- Flood
j- Fire F_ Liq F- Landslide F_N/A Floor Suite No
Description of Work dib /'-tis'vr f-0 z�--7p.1/ E ?0
Use#7�UConstType �A r
# Stories�� # Units (if Res)
/ 4�rwf /4-YV 1Ay45 _7-,Mr--
x -- =/ -- '
Valuation $ 00
Material/Labori
New/Add SF Remodel SF �� Garage/New/Add
OWNER'S NAME Last
First
Owners Address
I
Owners E-mail Address
City State I
I
�—
Zip �� Telephone;
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APPLICANT'S NAME Last; U%xX
First I /
Applicant's Address
Applicant's E-mail Address
74� (� (�j,p L� /d (/¢
Zt c�
City /Atj�� State Ili s
Zip 9 Telephone �¢y'-Zo�/�
CVLLiic_.
ARCHITECT/DESIGNER'S NAME Last /I/� -/
N -
First jl" A D�y
Architect/Designers Address
ArchitecUDesigner's E-mail Address
City State I
Zip Telephoner
ENGINEER'S NAME Last
First r�-- Lic. No.r
Engineer's Address
Engineers E-mail Address
i
1
City I State F
Zip TelephoneF_
CONTRACTOR'S NAME/COMPANY j �a�r
ry
�s
A _.... 1 Lic No. I � Class
1�•
Contractor's Address
Contractor's E-mail Address
City State �®
Zip Telephoneo
SETBACKS REAR SETBACKS FRONT
PERMIT NO. x1rolq ' C ��
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.l�i
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES