HomeMy WebLinkAboutX2019-1526 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
�euilding F_Grading [—Drainage 7Elec rMech F- Plum CuvdCut Cu Yd Fill
Project Address (Not mailing address) f Flood j` Fire r Liq ( Landslide I_N/A Floor Suite No
{(i,�J Sc//TE 70 N' r V kD � O
Description of Work
Use Const Type
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Valuation $
Material/Labor r D
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New/Add SF F_ Remodel S $ Garage/New/Add F
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address -
City
State F Zip [— Telephoner
APPLICANT'S NAME Last
bVAc (( First
Applicant's Address
Applicant's E-mail Address
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city �/CN f r i�4 Toii &c C14 State C.h Zip �d 6 <( (� Telephone �Z tea 9'16S7
/DESIGNER'S NAME
astFeN0 First
Architect/Designers gess
Architect/Designer'sE-mail Address
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City i�
State CA Zip 9/ Telephone
ENGINEER'S NAME Last
fN t iv O L First 5 `�} j (�F L',Lic No.F_
Engineer's Address
Engineer's E-mail Address .
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State— Zip�) fi Telephone _Lrtsfl_�aaLf f/ca0
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CONTRACTOR'S NAME/COMPANY
� Lic No. 9 6Vss? Class
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Contractor's Address
Contractor's E-mail Address
City 5�r TA !` rt N R
State e4 Zip �a -70 J Telephone %rS_��(_b�dy
SETBACKS REAR
SETBACKS FRONT PER
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. m
Iu5E ZONE DEVELOPMENT NO PLAN CHECK FEES $