HomeMy WebLinkAboutX2019-2956 - Permit Applicationx 2® K- 3c15L®
Pring Form Worksheet for Combo Building & Solar Permit Application �EWPo;
❑ Comm'i ❑ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c"
❑Building OGrading CDrainage ❑Elec ❑Meth E] Plum Cu Yd Cut Cu Yd Fill l
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Project Address (Not mailing address) C Flood ❑ Fire Liq E]Landslide ON/A FloorSuite No
Description of Work ��� L g J�
UseConst Type
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# Stories❑ # Units (if Res)❑
Valuation $ CG Y
Material/Labor l S CJ�J
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New/Add SF� Remodel SFGarage/New/Add
OWNER'S NAME Last Sh i),\ an Ie U First
Owners Address Owner's E-mail Address
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City State �j�.
ZiP � G -b 1—% Telephone 7tjn 7 ZD 31 C%
APPLICANT'S NAME Last, : S First
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Applicant's Address Applicant's E-mail Address
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City S &r-� A t;Ipc State U"— Zip Telephone / 1 SS (�- L.
ARCHITECT/DESIGNER'S NAME Last First (�—
�--- � Lic. No.
Architect/Designers Address. Architect/Designees E-mail Address
cityI State ZIP Telephoned
ENGINEER'S NAME Last ��� I First �,� • Lic. No.
Engineer's Address Engineer's E-mail Address
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city ,h'>v t',�,.fi+,A, .StateZIP LC' Telehone c � ��3�? � J p ��,� Zsy- -t7-
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CONTRACTOR'S NAME/COMPANY /' Lic. No.b J L-, 26,2 Class C
Contractor's Address Contractors E-mail Address
�� i t t�L�r�-(' ����•� ,/).`_ I �IFUt C1 (tiw 15 � 1 �.5-� ir, i i.C..Ch
City �ja r -f i—_k q, State7. 7 Zip 7 2 i ) Ci Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $