HomeMy WebLinkAboutX2019-2479 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application of '°R
Vomm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
( Building r Grading F Drainage r Elec Mech
r Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) I_ Flood F_ Fire r Liq F_ Landslide I`N/A Floor Suite No
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Description of Work
Use Const Type I�
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# Stories #Units (if Res)[_
Valuation ! V
Material/Labor —j
New/Add SFr Remodel SFF— Garage/New/Add F_
OWNER'S NAME Last �P`7L"
First .�
First
Owner's Address (r (( yQN {,i(A.I 'r
Ow nU4-mail Address
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Zip U Telephone[
APPLICANT'S NAME Last ( � First 1 6 Qf6
Applicant's Address
Applicant's E-mail Address
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City I SU , e� IS(}�CN() State
Zip ( l Telephone ��"J ESZ-�vO�J (�
ARCHITECT/DESIGNER'S NAME Last � First Lic. No.
Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City State J
Zip Telephone
ENGINEER'S NAME Last H i t\l�o /
t First C" ELT Lic. No.
Engineer's Address
Engineer's E-mail Address
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City Ut 4y I S _Iz. State C
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Zip Telephone -
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CONTRACTOR'S NAME/COMPANY6 l T �' Lic. No. $lf(I Class
Contractor's Address
Contractor's E-mail Address
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Cit 4' State (
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ 19�t .Zip
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