HomeMy WebLinkAboutX2019-1173 - Permit Applicationx a0\l 11,?�3
Print Form Worksheet for Combo Building & Solar Permit Application Q��WP�R>
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Residential City of Newport Beach - Building Division
Comm'I �, NOTE: PLAN CHECK FEES DUE AT TIME OF SUB,j1lR'TAL � \ ,[ F OP
uilding Grading Drainage Elec .Mech Plum dcutF `
/PrBoject Address (Not mailing address) C_ Flood F_ Fire � iq F_ L e F-N/A Floor Suite No
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All A
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i Work 4
Use &Nonst Type
# Stories # Units (if Res)r
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Valuation $ ""-`�"
Material/Labor J`F'- P'rC ' •
New/Add SF� Remodel SF Garage/New/Add
OWNER'S NAME Last UN SQ.I.t� First �,., s y N
Owner's Address Owner's E-mail Address
�rii t� . Vee1k9%UAVW00A@!n0Ch%10> o %*,5S . cruet
City State le,k Zip F—V 4C' I.......... Telephone ttof IN. 41TT
APPLICANT'S NAME Last j'9s" l ("'C1r1 First
Applicant's Address Applicant's E-mail Address
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IV ._: F" 2 �C.. c7.rits
City State Zip o a ° ', Telephone `J%tt d1S'5` 976d
CHITECT/DESIGNEE 'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City Sta a F Zip Telephonel�
GI EER'S N�ME Last First Lic. No.F_
Engineer's Address Engineer's E-mail Address
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City State F_ Zip Telephoned
CONTRACTOR'S NAME/COMPANY d(Lic. No. �'t' Class
Contractor's Address Contractor's E-mail Address
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City � State c Zip � `'�� � Telephone YA% e tttv)l
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $