HomeMy WebLinkAboutX2019-0726 - Permit Applicationvf-i
Worksheet for Combo Building & Solar Penult Application°°
F Comm'[ i Residential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �� ` O Z �° °��•"
Building ]—Grading F—Drainage F_Elec r—Mech Plum cu rdcatr — cuvdFill F
Project Address (Not mailing address) Flood F- Fire (- Liq F- Landslide FN/A Floor Suite No
�r vi"q
DeScnipto of Work
Ilse ,Const Type
C1)IrSo.
n
S r r r
#Storied #Units (if Res)
Garage/New/Add �—
Valuation $
Material/Labor—
II
Ne'w/Add SFF Remodel SF �—
OWNER'S,NAMELas{`
Kip05
First
Owner's Address 2 416
Owner's E-mail Address
City F. State
Zip— Telephonel'
APPLICANT S NAME ' Last
j n
First
;Applicant's Address
Applicants E-mail Address
:,City" �,t%'�!. 7 State �,i1
.Zip 2g"!u (,. Telephone "7
ARCHITECT/DESIGNER'S NAME Lasti
First Lic. No.
'; Archite6bDesigner's Address
Architect/Designer's E-mail Address
CityfState r
Zip
�— Telephoned
ENGINEER'SN I AME Last
First F Lic. No f
'. Engineer's Address
Engineer's E-mail Address
:City .State �i
Zip— Telephoner
CONTRACTOR'S NAME/COMPANY
o n Lic. No. 1 J7 5Ogg Z Class I 9
Contractor's Address ;
Contractor's E-mail Address
Sl4,0�`�'C,Q S/
I 17 �1C ��eQ �S�C� �OKJ A-1 • /)'e/
- ;City®Rryy3, State ("
Zlp I gG� Telephoned
SETBACKSREAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
" `WE'ZONE DEVELOPMENT NO
PLAN CHECK FEES S