HomeMy WebLinkAboutX2019-2470 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application ° m
Comm'I Residential City of Newport Beach - Building Division X TO 11 U7d
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
BuildingF_GradingFDrainage F_Elec rMech F- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood= r- Fire 7 Liq (—; Landslide FN/A Floor. Suite No _
Description of Work
Use ( Const Type
#Stories #Units (if Res)
C DC "�
^ 42
T—�
frf-7 /
i ij'
&C c.�_.,
Valuation $
Material/Labor /d 000
New/pdd Sfi Remodel SE�—
Garage/New/Add
O�IIfNER's.NAME Last//z
First
r
Owhs5a�'Address
Owner's E-mail Address �[
:City,rt� efir� State I : � ..Zip— :Telephoner
QRP.LICAWS NAME Last j r } h
First
Applicant's Address
Applicants E-mail Address
17
` ( 7]
bo2ie,/C( /LlrriS4)C�ce
Ctty'�_ State
Zip ? g-jP (� Telephone
ARCHITECT/DEsiGNER's NAME 1 Last!a.
Firsts Lie. No. �—
ArchftgctlDesigner!s Address
Architect/Designer's E-mail Address
Cify -State
Zip— Telephoned
ENGINEER'$ NAME Last l
First F Lic. No. —
Engineer s Address
Engineer's E-mail Address
Qity -State I
r—
Zip Telephone
CONTRACTOR'-NAME/COMPANY / /f
Lic. No. 3�90,T Z Class!
=Co- aters,Address -
Contractor's E-mail Address
S
t2 ('2p"P 41Ps to fo Aq f) 'e
State
ZipI 9 Telephonel �3
iETBACKS REAR SETBACKS FRONT
PERMIT
iETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO
75E z ttvr bitVELOPMENTNO
O I • f PLAN CHECK FEED'