HomeMy WebLinkAboutX2019-0558 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
(- Comm'1 r Residential City of Newport Beach - Building Division
niOTE• of oni r'Wf=r. C FFFS DDE AT TIME OF SUBMITTAL
[-Building 1 -Grading F-DrainageVrElec j-Mech f7Plum Cu rdcutF Cu rd Fill
Project Address (Not mailing address) C Flood F- Fire (- Liq F- Landslide F WA Floor Suite No
Description of Work
Use I Const Type
# Stories # Units (if Res)
valuation $ 100
Material/Labor 9�
New/Add SFF— Remodel SF �— Garage/New/Add F—
OWNER'S NAME Last I N POfi Cxtk L i First
Owner's Address Owner's E-mail Address
7 01 Fn/�tu?a�� Sr
City N State �— Zip 9.66-1 Telephone g•(+ 6� OgXZ
APPLICANTS NAME Last S^q, ITtt First�N,,s
Applicant's Address Applicant's E-mail Address
N ttI) N
S State I Qq_ Zip 9i7 0.r -_Telephone it 19/
City ..�; �- � �-1''.
ARCHITECT/DESIGNER'S NAME Last First F— Lic. No. f—
- Architect/Designer's Address Architect/Designer's E-mail Address
City State F— Zip F TelephoneF—
ENGINEER'S NAME Last 1/ • /r u First7q i� L, Lic. No.F
Engineer's Address Engineer's E-mail Address
I Siv QRoov, t4 w
^^ State Zip S Telephone -� (t SSI v
City �A/Sh 1`1N�} � 762
CONTRACTOR'SNAME/COMPANY 14#j +�US ( //� 4r Lic. No. M%({40 Classl7v
C'�ta' l.l7NSl
Contractor's Address Contractor's E-mail Address
city. 1,Zv Pt R_R #./ ,Ar- State �� Zip y� 2 OS` Telephonej7 S ► f ��
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
F1901MEM
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $