HomeMy WebLinkAboutX2019-3014 - Permit ApplicationPrint Form - Worksheet fo'r Combo Building &Solar Permit Application o4�` °°
F- Comm'I ( Residential City of Newport Beach - Building Division J�`oa
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r -Building Grading [-Drainage FElec j-Mech F -Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) (— Flood r Fire r— Liq f— Landslide rN/A Floor Suite No
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Description of Work
Use Const Type
# Stories #Units (if Res)
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Valuation $
Material/Laborl�1_10
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New/Add SFF— Remodel SF F -- Garage/New/Add F—
OWNER'S NAME Last G( (�d�GJ ' j First if ale "e✓
Owner's Address Owner's E-mail Address
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City7P or'f""... do State F(-. Zipr��- 6Telephonegy •f�ji
APPLICANT'S NAME Last First t ��
Applicant's Address Applicant's E-mail Address
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`100 W. U0 j" 611 ! -6d/ Ate! a/i �f a�/ >yd'/ %.
CityB � I� r Ld ora State eY 1 Zip yf7'/g Telephone �j2� 997
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip F TelephoneF�
ENGINEER'S NAME Last First F� Lic No.��
1
Engineer's Address Engineer's E-mail Address
City F_ State Zip F_ Telephoned—.
CONTRACTOR'S NAME/COMPANY /f�% i�VnyraZ�� Lic. No. i0 Class
Contractor's Address Contractor's E-mail Address
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City I�®6 State �� Zip q17 i Telephone �2*3 S�®E7
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SETBACKS REAR SETBACKS FRONT PERMIT NO. 1 I ,
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SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ' ® 107
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
10