HomeMy WebLinkAboutX2019-1965 - Permit Applicationerint Form . ' Worksbeet for Combo Building & Solar Permit Application a `WPo"a
Xy Comm'I r Residential
City of Newport Beach - Building Division 111,2e-,20157
NO.T��i PLAN CHECK FEES DUE AT TIME OF SUBMITTAL )(2n19 - /9s5 °"•°a""
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Description of Work
Use F Const Type
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# Units (if Rhe-y�.
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OWNER'S NAME Last Colvp l/v/
Owner's Address Owner's E-mail Address
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City /��� State �— Zip C_'2�p�7 Telephone q#t?.7720.6-Z7
APPLICANT'S NAME Last �(j�5 First 1��N1SE
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First I—r'
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City � State F_ Zip F_Te�—
Telephone
ENGINEER'S NAME Last est i2 First J6;- V® Lic. No.
Engineer's Address Engineer's E-mail Address
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City [(JN� %Ut State I �' Zip! $pS Telephone .3t0•SHQ•Z()
CONTRACTOR'S NAME/COMPANY PaCI�IC v ¢�� �6ViS�l�Il�Y1 fU1C9� y,_ Lic. No. FQ 970 Class
Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO. I 1
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $