HomeMy WebLinkAboutX2019-1698 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL U014-
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Project Address (Not mailing address) r— Flood (— Fire r Liq r Landslide r -N/A Floor Suite No
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Description of Work
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OWNER'S NAME Last IN= G MMyynI First OI br Vg
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Owner's Address E-mail Address
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`/ Zip VIq—' Telephone 46 }
City � I V I n� State �
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APPLICANT'S NAME Last to i I i-'orr First J -.190
Applicant's Address Applicant's E-mail Address
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City l : 1n n A n g State I 0/10\ Zip _q21 V I Telephoner_-,�,iO 5`r�) T
ARCHITECT/DESIGNER'S NAME Last First I Lic. No. F
Architect/Designer's Address Architect/Designer's E-mail Address
City F_ State F_ Zip F_ Telephoned—,
ENGINEER'S NAME Last I First F_ Lic. No.F--1,
Engineer's Address Engineer's E-mail Address
City �— State F_ Zip F—. Telephoned
CONTRACTOR'S NAME/COMPANY Y m o 1 I o q i � i 01 n� Lic No. 5_ � T /512_Class �5
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Contractor's Address Contractor's EI -mail Address
33r S- sUSgn 9-nei 1911 6rmprorn1o 0VG Us
City I i+ l r V I / 1n q State I V/ \ Zip q 2104. Telephone
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ` Z l
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $