HomeMy WebLinkAboutX2019-2203 - Permit ApplicationPrin{Form Worksheet for Combo Building & Solar Permit Application QW,
Comm'I FL,Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood I- Fire F- Liq [ Landslide CN/A Floor Suite No
Description of Worko
Use i Const Type
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#Stories �) #Units (if Res)��
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Valuation $
Material/Labor
New/Add SF Remodel SF Garage/New/Add i
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OWNER'S NAME Last I 1'_'. First ._" EFIV \�
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last First
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Applicant's Address k b'TES Applicant's Address
�E-mail
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City, _--_-__ __- State Zip ' TeleP hon -d o �t�5�' L-J- --
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ARCHITECT/DESIGNER'S NAME Last First Lic. No. '7-;' vJ�
Architect/Designer's Address Architect/Designees E-mail Address
city State Zip F_ Telephone[ ----
ENGINEER'S NAME Last ._ - _ First F Lic. No.�
Engineer's Address Engineer's E-mail Address
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City State- Zip Telephone_ .QLoq
CONTRACTORS NAMEXOMPANY _ _ _o,-----'Lic. No. f l�a't"� Class T
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Contractor's Address I IE.S�CcLtFF Co��%_5 \(>(JC,-ry0(v iUS3600
Contractor's E-mail Address
City (� State zip Tele hon -14i err
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SETBACKS REAR SETBACKS FRONT PERMIT NO. k� - !-Z
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USEZONE DEVELOPMENT NO PLAN CHECK FEES $