HomeMy WebLinkAboutX2019-2190 - Permit ApplicationaEW Po
Worksheet for Combo Building & Solar Permit Application o�
City of Newport Beach - Building Division q-. Q1 io
r Comm'I Residential , Foams
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building 7 Grading F-Drainage F- Elec - Mech - Plum Cu Yd Cut — Cu Yd Fill F
Project Address (Not mailing address) f— Flood r Fire i— Liq F- Landslide I -N/A Floor Suite No
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Description of Work Used i ConstType
0
New/Add SF
OWNER'S NAME
f, (.I:j6__ 1 61 1
Owner's Address
City
Remodel SF
Last
' 13 # Stories- #Units (if Res)'f
Valuation $ /
Garage/New/Add— Material/Labor 1 `J �vr
First l A-,) (7)
Owner's E-mail Address
State Zip �� Telephone;
APPLICANT'S NAME Last-�-
Applicant's Address
City ! /) �J State
ARCHITECT/DESIGNER'S NAME Last .
Architect/Des s Address
I
City
I State
ENGINEER'S NAME . Last
Fnnineer's Address
Firstly <r
Applicant's E-mail Address
p Telephone!
Zi � 6 � F
First 1 Lic. No. I
Architect/Designer's E-mail Address
Zip Telephone'
First
Engineer's E-mail Address
City { State Zip Telephonez
Lic. No.
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CONTRACTOR'S NAME/COMPANY ; 1 /"� l� � �-�(�r ��
Lic. No. 0� Classy
Contractor's Address 1 Contractor's E-mail Address
f Telephoner
City 1 /j j/�i �' `lt" 15r: �� State zip 9
SETBACKS REAR
SETBACKS LEFT
USE ZONE
PERMIT NO. n. 24
SETBACKS RIGHT PLAN CHECK NO.
DEVELOPMENT NO
f✓LAiV C tELi{ FEES
SETBACKS FRONT