HomeMy WebLinkAboutX2019-1680 - Permit Applicationx'210« - � W g o
Print Form_ Worksheet for Combo Building & Solar Permit Application �sn�,
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r, Comm'I r (Residential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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Valuation
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OWNER'S NAME Last n� I J n First �� r'
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last Olh r { S tit
First (; o Q
Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last �
', First F_ Lic. No. F_I
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State F_
Zip [—Telephone
ENGINEER'S NAME Last
First F Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State F
Zip F Telephone
CONTRACTOR'S NAME/COMPANYh irUm o "h o nl� ging Lic. No. ZU51 Z Class
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Contractor's Address
Contractor's E-mail{Address
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. X 0 IC �p�O
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $