HomeMy WebLinkAboutPV2019-053 - Permit Application7%) 20 P a5-2�D
Print Form Worksheet for Combo Building & Solar Permit Application ozEsPoam
City of Newport Beach - Building Division
F Comm" Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) (® Flood r Fire ( Liq F_ Landslide FN/A Floor Suite No
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Description of Work
Use ConstType�
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#Stories # its (if Res)
Valuation $
Material/Labor i
New/Add SFF -- Remodel SFI-
Garage/New/Add I
OWNER'S NAME Last i ;�
First
Owner's Address
Owner's E-mail Address
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City (Vewpori [3e&a) State--- Zip Fj_T_6_6T_Telephoner
APPLICANT'S NAME Last M , I
First I -ry "A
Applicant's Address
Applicant's E-mail Address
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City I F,11.fr,,:jr✓ State
Zip 233 Telephone q71o6-,5`f l
ARCHITECT/DESIGNER'S NAME Last �_--_
First F_ Lic. No.
Architect/Designers Address
Architect/Designer's E-mail Address
CiTy State I-'
Zip f Telephone F_
ENGINEER'S NAME Last
First F_Lic. No.1
Engineer's Address
Engineer's E-mail Address
City r- State F--
Zip r--- Telephone)
CONTRACTOR'S NAME/COMPANY S � C
LA (L S IC /V Lic. No. Class � k�
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Contractor's Address$$q
Contractor's E-mail Address
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14(da GA OLR S' t, R j� , c 0/11
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Zip °� z (i ( Telephone j7 CI - 6q_q GT d
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N0. 09 17-'Z-ol
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $