HomeMy WebLinkAboutX2019-0635 - Permit ApplicationPrint Form '0 Worksheet for Combo Building & Solar Permit Application
n Comm'I Residential City of Newport Beach - Building Division C)g5q-,?01%
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL � 2n A? --(Z
(Building r Grading rDrainage NElec rMech r Plum cu yd cut Cu Yd Fill
Project Address
�V95
of Work
add
n Flood r Fire rj Liq r, Landslide �N/A Floor
I
Ax2
New/Add SFF —770— —_ Remodel SF `72 9�r-
Garage/New/Add
Suite No
I
Use F57 Const TypeT—
# Stories # Units (if Res)
Valuation a
—C Material/Lbor
a
OWNER'S NAME Last I��� First
Owner's Address
City State G/A-
APPLICANT'S NAME Last
Applicant's Address
City State F—
Owner's E-mail Address
Zip q7Z Telephone `Z/if- 79_4?— O-/
First
Applicant's E-mail Address
Zip �� Telephone
ARCHITECT/DESIGNER'S NAME
Last � ���j�� First F/;-/"/ Lic.
Architect/Designer's Address
City �r___y �% iil_ State
Architect/Designer's E-mail Address
Zip /a- V Telephone'? p�2
ENGINEER'S NAME Last I First F Lic. NoF
Engineer's Address
City State F
Engineer's E-mail Address
ZipF Telephone
CONTRACTOR'S NAME/COMPANY A Jlc� Cb n SM�� N Lic. No. L{ a S �t Class FI
Contractor's Address
City I q , LrijA SState I cx�
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
vV\Ja°2C'lA i COwS�(tJc�ti J60&A C C0rh
Zip �Z66 Z TelephoneFm - 671 'tl L
PERMIT NO. Y 7 t- -1
PLAN CHECK NO. _
PLAN CHECK FEES $