HomeMy WebLinkAboutX2019-2437 - Permit ApplicationF/c, �-- e- if -S
Worksheet for Combo Building & Solar permit Application °cEW"°�
( Comm'I r 'Residential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DIIF AT TIME OF SI IRMITTAI
Building r` Grading i` -Drainage I—Elec F_Mech L Plum Cu rd cut Cu Yd Fill
Project Address (Not mailing address) (- Flood r Fire F_ Liq F Landslide r'N/A Floor Suite No
Description of Work
Use � CanstType
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# Stories, #Units (if Res)7'
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Valuation $. ,l
Material/Labor *
New/Add SFF— Remodel
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SFF- Garage/New/Add
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OWNER'S NAME Last
Z First
Owner's Address Owner's E-mail Address : -
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City -,?. D
�' State X .Zip fq:� �{ v _:.Telephoner
APPLICANT'S NAME.Last
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L/���5f�� First
Applicants Address'
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1 Applicant's E-mail Address UU /ry
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City lL1az.� . ��
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State FTZip d3�.. Telephone �`%U`2 o� c(,e.,
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ARCHITECT/DESIGNER'S NAME
Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City. r
State F Zip F Telephones
ENGINEER'S NAME. Last
First �j/ �` Lit. No.F ._ 1V„/�.
Engineer's Address
Engineer's E-mail Address
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. e),107 —
City �� _--State
G .Zip G};J Telephone 7/`,1)^i7—
CONTRACTOR'S NAME/COMPANY
Thy Lic.No. },��11 Classes
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Contractor's Addy{rres�ss
Contractor's /E-mail Address
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City ,,,Q��r�� ✓ .,
State Zip t.� Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. \ZC� l (���3 -7
SETBACKS, LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE - -
DEVELOPMENT NO - - PLAN CHECK FEES $