HomeMy WebLinkAboutX2019-2706 - Permit ApplicationPrint Form Worksheet for Combo Building $ Solar Permit Application o.fy"e
r Comm'I jt/ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL +•'
(Building r` Grading f—Drainage F_ Elec r Mech
F Plum CuvdCut � Cuyd jcii
Project Address (Not mailing address) F Flood
F_ Fire j— Liq (- Landslide /A Floor Suite No
Description of Work
Use I— Const Type
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# StoriesF.—),—U Res)F
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Valuation $
Material/Labor
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New/Add SF �� Remodel SFr ...y� Garage/New/Add
OWNER'S NAME Last
First
Owners Address
Owners E-mail Address
City '/� State "•"
Zip 612k63 TelephoneF
APPLICANT'S NAME Last r Dc S., r
First
Applicant's Address
Applicant's E-mail Address
3l ,Jac Ke-v�M G�r..vc-
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City i o� , ��� �� State f
Zip Q ? 4e?4 Telephone W•4Q-636_ 1 Y S
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designers Address
Architect/Designer's E-mail Address
City State
Zip �� Telephoned
ENGINEER'S NAME Last t a�� ,
First �1n1 rnt L k. No. y—
a
Engineer's Address
Engineer's E-mail Address
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T,.-t—
lu-eusc�.,.r���r✓�.co�-�.
City State Ct3,
Zip Ct* Telephonel_71.7-112-0
CONTRACTOR'S NAME/COMPANY s�C r / n rµ4 L� Lic No. ;ke,?S 3 Class
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Contractor's Address
Contractor's E-mail Address
City State CFI'
Zip F9261Telephone q _63i.-,e)(�i ;
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 7�K� I •2—� OLD
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N . 2j
USE ZONE DEVELOPMENT NC
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� • 0�- O� PLAN CHECK FEES $