HomeMy WebLinkAboutX2019-0178 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division o=
j` Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing^ address) f— Flood r" Fire r" Liq (—" Landslide f_N/A Floor Suite No
Description of Work
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Use Const Type ,
# Stories # Units (if Res)F
Valuation $
Material/Labor
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New/Add SF Remodel SF Garage/New/Add
OWNER'S NAME Last 1.6b6 1 I C�c First
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last ��) L�� First
Applicant's Address Applicant's E-mail Address
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CONTRACTOR'S NAME/COMPANY cl b Lic. No. V(Ki ss
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Contractor's Address/►= Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
Print Form Worksheet for Combo Building & Solar Permit Application
F Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTALNT�
Building (- Grading j-Drainage (- Elec f` Mech j- Plum Cu Yd cut Cu Yd Fill
Project Address (Not mailing address) r- Flood f- Fire (" Liq r Landslide F_N/A Floor Suite No
0 �0'� � �-
Description of Work
New/Add SFFAVM Remodel SF y Garage/New/Add /LI /j
"� 7 -
OWNER'S NAME Last First
Use - ConstType
1
# Stories # Units (if Res)Fj
Valuation $
Material/Labor 1 q10I ®0n
Owner's Address Owner's E-mail Address
City ' .� State
Zip r� � � Telephon jl
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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City State \ Zip t � Telephone -7 �_'_% -<�� 4I
ARCHITECT/DESIGNER'S NAME Last C
\ First Lic. No. �) 1
Architect/Designer's Address
Architect/Designer's E-mail Address I
City State Zip Telephone' �� ( 2 C
ENGINEER'S NAME Last �First Lic. No.
Engineer's Address _ Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY Lic. No,
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Contractor's Address Contractor's E-mail Address
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City( jj _
1 State- Zip Telephone
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
PERMIT NO. y
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $
1. Prmt:Fo�rri Worksheet for Combo Building & Solar Permit Application
[7 Comm') Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building j` Grading f—Drainage f— Elec f— Mech
Project Address (Not mailing address) f- Flood
1`_ -P . kv
Description of Work
New/Add SF
Remodel SF
OWNER'S NAME Last t ^11 tt t
(— Plum Cu Yd Cut Cu Yd Fill F
F_ Fire f— Liq F_ Landslide f7N/A Floor Suite No
Use Const Type.
# Stories # Units (if Res)
Valuation $
Garage/New/Add r/;( Material/Labor
First
Owner's Address Owner's E-mail Address
City _'_ (VQ. .._ .. State cx Zip Telephon4 I _ .7 /! �z
APPLICANT'S NAME Last ��' ��� First
Applicant's Address
City (( pA 1) State Zip
v �..`�' �
Applicant's E-mail Address
t!C Telephone 1 4 - -�c7-9`) `1'(
ARCHITECT/DESIGNER'S NAME Last 1 19V � C�, First
Architect/Designer's Address
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City I IV—V L C� State
Lic. No. •-19 0 J
Architect/Designer's E-mail Address /
Zip , Telephone q-( t d.� 1
ENGINEER'S NAME Last First Lic. No.,
Engineer's Address Engineer's E-mail Address
• J_ _ ti06,11-
City b i A State c Zi Tele hone�'j C L 5
CONTRACTOR'S NAME/COMPANY (L , j Lic. No. �q-,��ssr
Contractor's. Address Contractor's E-mail Address
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City �` (L ► ! State Zip n !� Telephone /Va—� 34ZZ//
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO. y UL 6 r
PLAN CHECK NO.
( � I
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $