HomeMy WebLinkAboutX2019-0479 - Permit ApplicationX2u ja - p
s' PfinntForm Worksheet for Combo Building & Solar Permit Application
Comm1 j Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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P<Building [-;Grading [—Drainage 6"Elec [-Mech 'Plum Cu Yd Cut) Cu Yd Fill
Project Address (Not mailing address) [- Flood [- Fire [- Liq [- Landslide [-;N/A Floor Suite No
Description of Work qr
Use F—ConstType
# Stories; # Units (if Res)
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Valuation �t :,ev
Material/Labor bor r
New/Add SF�— Remodel SFF,// I Garage/New/Add �
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OWNER'S NAME Last���/�J`���d��.�,ej First
Owner's Address Owner's E-mail Address
City State Zip /"v j TelephoneF_
APPLICANT'S NAME Last First �,105"Ie
Applicant's Address Applicant's E-mail Address
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City ) State F74 Zip Telephone R '�Liel t>e-j V
ARCHITECT/DESIGNER'S NAME Last ;j7,"ki4* first Lic No4�'YL /_-!�4
Architect/Designer's Address Architect/Designer's E-mail Address
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City State F Zip ' TelePhone�— �.....
ENGINEER'S NAME Last —s� First F Lic. No.F
Engineer's Address Engineer's E-mail Address
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City —�I State F_,. Zip I Telephone[
CONTRACTOR'S NAME/COMPANY f � � n /- / Lic. No. DDT_ Class
CU+-�CCon�tracctor's
Contractor's Address E-mail Address
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City I State I �� Zip Oa %�% TelephoneF3/ 0.
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SETBACKS REAR SETBACKS FRONT PERMIT NO. XsM .04-11
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Dsrot-4011
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $