HomeMy WebLinkAboutX2019-0816 - Permit ApplicationPrintf Form '; ;. Wo eet for Combo Building & Solar Permit Application
tiSyftm I �Residentia City of Newport Beach - Building Division o a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL °.aw�•'
wilding [Grading rDrainage
_5-<Elec 'Tech Fum CuvdCut F CuvdFill
Project Address (Not mailing address) r Flood r Fire r,, U r Landslide N/A Floor Suite No
Description of Work Use F—Const Type FV >3
# StoriesT # Units (if Res)F
-- --- — --
�) Va Material/Labor $ [ S
New/Add SF� Remodel SFF—
Garage/New/Add Material/Labor ✓ ✓/
OWNER'S NAME LastFirst
Owner's Address Owner's E-mail Address
city lt/( l)-4 _5GA (J4_ State Zip_. 7hGj L.__ Telephone 7�y �i 473—64-Y)
APPLICANT'S NAME Last /J/%I First
Applicant's Address
City %� &-)Ef-, -_, --_- State—I
Applicant's E-mail Address
Zipl��L`-. Telephone ys., 3.1
ARCHITECT/DESIGNER'S NAME / -
Last l�� ,First 2� yCjE� Lic. No.
Architect/Designer's Address
5-7(,l VVA Lb
City Z?7vj,&��— State
ENGINEER'S NAME Last
--fit
Engineer's Address
City State
Architect/Designers E-mail Address
C Sec,' C �
Zip _2/ Telephone � _� ��_,2V/7
First ,...: 4.
ieer's E-mail Address 2
Zip—; Telephone
CONTRACTOR'S NAME/COMPANY �01 � _� n GjJ� Lic No. 6G %y Class;
Contractor's Address
57Z.�KIrQ
City State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
V141a1 S�iC��CCr� , i✓U] L��,l
Zip Telephone 5 . Z/
PERMIT NO. V./Cl"1'�
PLAN CHECK
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $