HomeMy WebLinkAboutX2019-1582 - Permit Application_Print Form Worksheet for Combo Building & Solar Permit A plication��Re
F_ Residential
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City of Newport Beach - Building Division q • G®
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� NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rv6u!lding r Grading f—Drainage P<ELec F�iW_h um CuvdCut CuvdFill
Projer�cti Address (Nott mailing address) f— Flood - F" Fire F— Liq F— Landsli F_N/A F�loor��"S'uite_No
Description of Work
UseFT'ConstType
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# Stories # Units (if Res))
Valuation $
Material/Labor L
New/Add SFr JL? Remodel SF-?� Lj�---- Garage/New/Add
OWNER'S NAME Last First U ,
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Owner's Address Owners E-mail Address
City State & Z Zip Telephone :,-yrr- 36 -o`L)p &
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First
APPLICANT'S NAME Last C�VCaGyi�
Applicant's Address Applicant's E-mail Address
4 il e R a ( 6 � 'r-1 67/01 Ct t , �7 VYV1 Gi G6 (h
City T\� State Zip a1266 Telephone � -400 — r4 �
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ARCHITECT/DESIGNER'S NAME - Last (2i First - + 3
�` � �� QU Lic. No. �
Architect/Designees Address Architect/Designer's E-mail Address
City State F_ Zip'— Telephone..-
ENGINEER'S NAME Last First Lic. No.r —
Engineer's Address Engineers E-mail Address
City State Zip F TelephoneF—
CONTRACTOR'S NAME/COMPANY pt Lic. No. DS17 � ClassI
c era FcrILID a?S
Contractor's Address ContractorsE-mail ddress
City �� )- State Zip' a-6 L Telephone
t t c
SETBACKS REAR SETBACKS FRONT PERMIT NO. etarJ
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO`PLAN CHECK FEES $