HomeMy WebLinkAboutX2019-3351 - Permit Application (3)print Form Worksheet for Combo Building & Solar Permit Application
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Comm'I Residential — 55 I
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�� Sr 0._�y City of Newport Beach - Building Division � �
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �+<�.oaN"
Building r Grading (—Drainage r', Elec [_ Mech Plum Cu Yd Cute' Cu Yd Fin F v
Project Address (Not mailing address) F Flood r Fire r Liq r Landslide r_N/A Floor Suite No
Description of Work
Use', Const Type
4W M
# Stories #Units (if Res)
IM.#
-- - -- ---
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Valuations
Material/Labor?/¢,aD
New/Add SF� Remodel SF
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Garage/ _ 1_4 y ,
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OWNER'S NAME Last ��fi/(�
First'/�� L�
Owner's Address
Owner's E-mail Address
az-7
City VAV State 5v /I
Zip s 9 , phone
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APPLICANT'S NAME Last �� '
First
Applicant's Address
Applicant's E-mail Address
City%'t%'� State
Zip ���� Telephone
ARCHITECT/DESIGNER'S NAME Last % ��T^ First.
�!� Lic. No
Architect/Designees Address
Architect/Designer's E-mail Address
City �) ,u y � State 14� r
Zip � IG/ Telephone Av --,z e;,?14
ENGINEER'S NAME Last VANFirst—, Lic. No.1,a
Enngineer's Address
Engineer's E-mail dress
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City State �
Telephone �•�f� d��/
Zip _i /
CONTRACTOR'S NAME/COMPANY Rekfk' ' t
lt'V�%�� Lic. No. ? fOwli Class
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Contractor's Address
Contractor's E-mail Address
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City N� state l u�
Zip 1 l�17 �Od Telephone q V' e6 i —t g (q
SETBACKS REAR SETBACKS FRONT
2c PERMIT NO. X C l� — 3�✓S I
SETBACKS LEFT (L SETBACKS RIGHT
/D PLAN CHECK NO. 5 — Z
USE ZONE (t-1 •-6,000 DEVELOPMENT NO
PLAN CHECK FEES $