HomeMy WebLinkAboutX2019-1912 - Permit Applicationk�01g-1 �f7
Priht,Farm. Worksheet for Combo Building & Solar Permit Application no,
Comm'I ResidentialCity of Newport Beach - Building DivisionNOTE: PLAN.CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) r-, r Fire F' Liq r Landslide F-IN/A Floor Suite No
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Description of Work
Use ConstT YPe
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all Ca � �
Stories � lUnits
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Valuation $
Material /Labor
New/Add SF[ Remodel SFj
Garage/New/Add F
OWNER'S NAME Last G a h eh
First
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME LastU'� �6�
First fJ 4J
Applicant's Address
Applicant's E-mail Address
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Zip (ani rD.... Telephone .$�63^7 i "-6gP7
ARCHITECT/DESIGNER'S NAME
Last
First F Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City f ----- State F__7
Zip I Telephone—
ENGINEER'S NAME Last
I First F Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City _. _. State F
Zip —i Telephone....
CONTRACTOR'S NAME/COMPANY Ur >A Lic No. 9 y i r. Class C q
Contractor's Address
Contractor's E-mail Address �J09(gl�
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Zip TelephoneF�6 a - 4y? -t
SETBACKS REAR SETBACKS FRONT
PERMIT NO. X-I/o6c-i • 1 Z.�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 3
USE ZONE DEVELOPMENT NO
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PLAN CHECK FEES $ SS_p ,`•�--�