HomeMy WebLinkAboutX2019-2443 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
I Residential City of Newport Beach - Building Division (1.g F Grading [-Drainage F_ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTALBuildi Elec F Mech j`
- Plum
Project AddresCu Yd Cutl Cu Yd Fill I
s (PI®i mailing address) I` Flood f Fire
// Liq j Land F_'N/A Floor Suite No
Description of Work
Use Const Type FV
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v / ,,�e. / #Storiesr
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New/Add SFF�'
Remodel $FGarage/New/Add I Valuation $.
Material/Labor F,
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OWNER'S NAME r °C
I "l l First
Owner's Address Last
Owner's E-mail Address
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Zip Tele
phone—
APPLICANT'S NAME
Last
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Applicant's L!-
Address
t, Applicant's E-mail Address
City
State I elf Zi �
P- `I J�S�:.� Telephone
ARCHITECT/DESIGNER'S NAME �l
Last First—
. Architect/Designer's Address - .Lic. No. �!
Architect/Designer's E-mail Address
City
state �— Zip
Telephoned i
ENGINEER'S NAME
Last �.� ,
First
Engineer's Address ' �-� �.�, Lic. No. ._ 4 9j� vim!
1 7L`A/ ,Engineer's E-mail Address
k ill. Ails
City
Stater
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_. 4 Zip r12�� Telephone �i/'T)cj"<3 7— %% ✓
CONTRACTOR'S NAME/COMPANY r
�u s' ,�. ��l�,s;e,-.4 �Lic No. crc
Contractor's Address r Snr__„ �_ } `/ /1_ _ Class _
��,r L Contractor's E-mail Address I
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City � % �•-JS t'��st>., C� �X ,..,.7� e��
.�, State
r c utr/: Fteb, s✓,e ..,. (,1 Zip_
_ _.. ._. //7S;r Telephone
SETBACKS REAR SETBACKS FRONT t
SETBACKS LEFT -------- PERMIT NO.
SETBACKS RIGHT
USE ZONE ----_ _ PLAN CHECK N0.
DEVELOPMENT NO ---
PLAN CHECK FEES $