HomeMy WebLinkAboutX2019-3684 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I f Residential City of Newport Beach - Building Division x �( -3log I —:
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL -
rBuilding F_ Grading F Drainage [_ Elec F_ Mech F_
Plum CuYdCut CuYdFill
Project Address (Not mailing address) F= Flood F_ Fire F= Liq F_ Landslide F_N/A Floor Suite No
11NO Tr v\ F- F---_
Description of Work
Use I—Const Type
1
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# StorlesF #Units (if Res)
Valuation $
Material/Labor)
New/Add SF Remodel SF �� Garage/New/Add F—
OWNER'S NAME Last t
ITS CAM V\ S L%ti First �C � Lln
Owner's Address
Owner's E-mail Address
City N?ff (k��c C�State C,{Jr ZiP r7C� Telephone[ —
APPLICANT'S NAME Last / r-t-, s3 First f 2 Y ew,�_-
Applicant's Address
Applicant's E-mail Address
City �i(�l)_' ate C.IZiP / 2/ S U Telephone"�
l
ARCHITECT/DESIGNER'S NAME Last F� First F_ Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City �- �� State �� Zip �— Telephone�—
ENGINEER'S NAME Last First F_ Lic. No.F_
Engineer's Address Engineer's E-mail Address
City State F— Zip �� Telephone[�
CONTRACTOR'S NAME/COMPANY LjG (/` U✓i�: SS / L Lic No. R& L/7 y Class 27
Contractor's Address Contractor's E-mail Address
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0 -732_
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City )1jQA)\)e0 C f i1JC L.(,1,'� State CCU- ZIP Fq Telephone � 7 S- �(-['
SETBACKS REAR SETBACKS FRONT PERMIT NO. ) 4
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $