HomeMy WebLinkAboutX2019-4044 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
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F_ Corim'I (- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DIJF AT TIMF nF qi iRRAITTAi
yZ Building Grading Drainage ElMech ( Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) C Flood (" Fire F_ Liq F_ Landslide 7N/A Floor Suite No
Description of Work
Use ConstType V --
N 1
00
f
# Stories[ If Units (if Res)
Valuation $ _
New/Add S ' Remodel SF �—
Garage/New/Add �-
Material/Labor
OWNER'S NAME Last rC>11
First -
Owner's Address
Owner's E-mail Address
-7 KtN
City, rJ Ew00t'-r � � State �,L Zip 71 L(,,3 TelephoneF—
APPLICANT'S NAME Last J�t-)
First �✓1 t`� [ �
Applicant's Address
Applicant's E-mail Address
City ` f, P4�&Z State ��(`'r`y
Zip -J Telephone r, - / -
ARCHITECT/DESIGNER'S NAME
Last I y� First g4I6 Lic No F—
Architect/Designer's Address
Architect/Designer's E-mail Address
j?C. C. j a �� � 1
(l zc� t. w;Oc ,O��i4 A)
City �7 /_` (1.., ;%1 State C�—
Zip q? ,, / Telephone ,1111 AD 3N 1
ENGINEER'S NAME Last nJ
First tJ Q �� �J Lic No. F_
Engineers Address
Engineer's E-mail Address (-P zta s3
i J��, P�G!�rczsl�i— Lart�
city�—
State r
� n
Zip �(� i TelephoneF, i4 ( -j !f�
('F/
CONTRACTOR'S NAME/COMPANY
LT
r Lic No. Class
I , P� ciTk
Contractor's Address
Contractor's E-mail Address
City State L />
Zip [ Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 0,4�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. �. �3 _ ICE
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $