HomeMy WebLinkAboutX2019-0013 - Permit Application (2)II _ 0=
Print Form Worksheet for Combo Building & Solar Permit Application
r Comm'I j Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
1 Building F-Grading [Drainage F7.Elec r-Mech F-Plum CuvdCut I
Project Address (Not mailing address) F_ Flood i- Fire [ Liq [ Landslide
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of Work
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Remodel
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[N/A Floor Suite No
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Use q/✓ ConstType Fvfj
# Stories7i # Units (if Res)
Valuation $�
Material/Labor
OWNER'S NAME
Last 0. V� First L_. _-- _
Owner's Address Owner's E-mail Address
city _� State C A _- Zip ���_ Telephone 7/72
APPLICANT'S NAME Last I �/�. 47,A, 2 First
Applicant's Address } � n Applicant's E9-mail Address
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State Zip a - Telephone d- &()-�(���7
ARCHITECT/DESIGNER'S NAME Last First FE_ Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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city tss v �, � }
State .. C-k- _.,.. Zip q�(t, j Telephone � q
ENGINEER' NAME Last I First I- Lic. No.1
Engineer's Address Engineer's E-mail Address
City State �— Zip �— Telephone
CONTRACTOR'S NAME/COMPANY Qp 'qLic. No. gJ� (18 'I(P Class
Contractor's Address Contractor's E-mail Address Qi%'✓ / 0 -drift
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1b t� u Ltity� 51,_ t'3U5- ��jt�tCo{ n c'v�taal i
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City ,.,`l�c,C t ✓�_ '�:-'� <<.�v State Zip ��. Telephone P14
SETBACKS REAR SETBACKS FRONT PERMIT NO. >\ C4)l -2 - (jU I
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Uoccl 1 510I
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ � U') G O%"