HomeMy WebLinkAboutX2019-2122 - Permit ApplicationPrint Fom; _ Worksheet for Combo Building & Solar Permit Application acs,
City of Newport Beach - Building Division
r Comm'I r Residential sinTF pi AN CHECK FEES DUE AT TIME OF SUBMITTAL.o."'
PBuilding F-Grading j-Drainage Elec j Mech Plum CuYdCutI CuvdFillI
roject Address (Not mailing address) F_ Flood r Fire j— Liq r- Landslide F_N/A Floor IFSuite�No
Description of Work Use I;ryConstType S l r
G �� �rjjzuLj v1 f l S 65 f' � , (0G 1 �4in ul. ! d ��
# Stories #Units (if Res)[
� Valuation I r�}/aoO
New/Add SF�— Remodel SF /r �— Material/Labor
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OWNER'S NAME Last '�'1 �y ��V 11/�Garage/New/Add v�'�� � - First
Owner's Address Owner's E-mail Address
State CCity - p L &' j'7 Teeaphone �j j 6i,. "LU -
APPLICANT'S NAME Last �('�1'� First f zK
1�
Applicant's Address Applicant's E-mail Address
City �/ �'-��i �i. State G Zip �2'yjl,� Telephone �:-2. G.-"1�� Z' ]�/
ARCHITECT/DESIGNER'S NAME Last bir.(r, First �N � Lic. No. G I -' �IS
Architect/Designer's Address Architect/Designer's E-mail Address
CityV , ,GZ'r `� I' P 1�.�.G:. "ll Telephone�
1 I�� State Zip I II
ENGINEER'S NAME Last First— Lic. NoF—
Engineer's Address Engineer's E-mail Address
city State J Zip F— Telephoned
CONTRACTOR'S NAME/COMPANY t�f)AAW Lic. No. F— Classr—
Contractor's Address - Cro'nt-r1actor's E-mail Address
City State �- Zip F— Telephone�—
SETBACKS REAR SETBACKS FRONT PERMIT NO. ,rD L^7'l -7A [ Z
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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