HomeMy WebLinkAboutX2019-1039 - Permit Application (3)Print Form Worksheet for Combo Building & Solar Permit Application
o� City of Newport Beach - Building Division
Comm'I Residential MnTG: PLAN CHECK FFFS DUE AT TIME OF SUBMITTAL o"� 1025�_
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r—Building (7 Grading F—Drainage F_ Elec [ Mech Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) F Flood Fire I— Liq F_ Landslide F_N/A Floor Suite No
416 luc_ F_
Description of Work Use F Const Type F
# StoriesF_ # Units (if Res)[7
Valuation $ 3 ��� ov
New/Add SF Remodel SF Garage/New/Add Material/Labor �
OWNER'S NAME Last r )p� First,
Owner's Address Owner's E-mail Address
City _NgeAj ta-Z-;t- - State Zip �� Telephone 2'72�',%
APPLICANT'S NAME Last 404 L W/ I First
Applicant's Address Applicant's E-mail Address
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City 4Qjz&/t/A C State [ Zip ZIo Telephonea!`l_g/2 s%2�
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City State — Zip C� Telephone
ENGINEER'S NAME Last First Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip Telephone
CONTRACTOR'S NAME/COMPANI(L: Lic. No. `�/� / Class
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Contractor's Address Contractor's E-mail Address
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City5----(ri / State Zip ���q�' Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. d
USE ZONE DEVELOPMENT NODN 11 i PLAN CHECK FEES $
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