HomeMy WebLinkAboutX2019-3559 - Permit Application (2)Print Form Wks eet for Combo Building & Solar Permit Applicatio se
Comm'I r Residential City of Newport Beach - Building Division i, \` NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
KiBuilding r Grading Drainage �(Elec /xI*ech Plum Cu Yd Cut cuYdliu
Project Address (Not mailing
address) F_ Flood r Fire I— Liq r Landslide rN/A Floor Suite No
Description of Work
Use�ConstType '�
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# Stories[ # Units (if Res)F
Valuation $
Material/Labor I �Uo eov
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New/Add SF�— Remodel SF� —({ Z�y Garage/New/Add �—
OWNER'S NAME Last/
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�.._ �I'V I1J��i..(.✓.'. First
Owner's Address
Owner's E-mail Address
City _.. 2 iz C/j!✓ /
- State
F 67 Zip 1 TTj Telephone g 7/ .L -J
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APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
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City 67.11i��
State L'/'< Zip....� Telephone t7%G..'1.1.� Z�
ARCHITECT/DESIGNER'S NAME
Last I -r jJh�l' f�t� First r4,14 L Lic. No. r; (,1
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Architect/Designer's Address Architect/Designer's E-mail Address
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City 1r�(E1/r7l%Lr
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State I " ZiP�Lr!%•._'G/ Telephone r� G% - �.Oj•- ��'�i
ENGINEER'S NAME Last
First Lic. No.�—
Engineer's Address
Engineer's E-mail Address
City
—
State �— Zi Telephone
CONTRACTOR'S NAME/COMPANY
U� Li -. No. �— Class
Contractor's Address
Contractor's E-mail Address A
City
State �— Zip F—_, Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT N0. 1
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK N0.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $