HomeMy WebLinkAboutX2019-0554 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
i- Comm'] r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F. -.Building F- Grading F -Drainage I-Elec F-Mech F- Plum Cu Yd Cut l Cu Yd Fill F_
Project Address :(Not mailing address) [ Flood F- Fire F- Liq f- Landslide CN/A Floor Suite No
Description of Work
Use F—Const Type F_
# Stories # Units (if Res)-
�t ck4_ SZ
Valuation $
New/Add SF�— Remodel SF Garage/New/Add
rOO _
Material/Labor I1
OWNER'S NAME Last I N�_wpOr First
Owner's Address Owner's E-mail Address -
7, o i -s: w-, rL*up, m ST
p
City N 4 _ ... - State — Zip 1i.66 Telephone q q 31 o
APPLICANTS NAME Last First
Applicants Address Applicant's E-mail Address
City - _ State I Zip? Telephone—
ARCHITECT/DESIGNER'S NAME Last First r Lic. No.
Architect/Designer's Address Arcbitect(Designer's E-mail Address
City �— State Zip F Telephoned
ENGINEER'S NAME Last 1<I 1 A 0 First Q II A 4/ � Lic. No.F
Engineer's Address Engineer's E-mail Address
a.0 (31Z00VC 140W.,0W S
Cityl S^VT State Zip .C1 -70� Telephone 1 4 6 61 QSI D
CONTRACTOR'SNAMEKOMPANY �s�US �, tT�� G:iNi� Lic. No. F Classl
Contractors Address Contractor's E-mail Address
i ti-l4'Lr C'I�wyo+y � , ft,
Ci Fl..� State Zip 1 �� ps` Tetephonel 'j�
b Aj a^__ _RA l� I . �-1+ It S f? 119 1
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. Xw.Or'
PLAN CHECK NO.
PLAN CHECK FEES $