HomeMy WebLinkAboutX2019-3768 - Permit ApplicationPdntForm: Worksheet for Combo Building & Solar Permit Application o4w�
F- Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL s.-ro••"
Building F_Grading Drainage j Elec j7Mech Plum CuYdCut CuydRIF
Project Address (Not mailing address) F_ Flood F_ Fire j- Liq r- Landslide rN/A Floor Suite No
Description of Work / Use ,f.ConstType
Storire�sFV #units (if Re1lsr
ValuationVenl/ a
New/AddSFF Remodel SF� Garage/New/Add Material/Labor j L'
OWNER'S NAME Last fl �''.�//�1 �11 y��i'Y h✓ - First
Owner's Address Owner's E-mail Address
City Z fz V iltV ]i + State Zip Telephone -1 _�j
APPLICANT'S NAME Last y;p. First
Applicants Address I Applicant's E-mail Address
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City ((���.. ��� State G•k Zip I ��L'� Telephone F_�"67
ARCHITECT/DESIGNER'S NAME Last I t?P r First to Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
z1" til
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City (�If•=b✓�ljc� f�rLj� State FCY` Zip G(7�.G �.C1 Telephone
ENGINEER'S NAME Last � First F_ Lic. No.F——
Engineer's Address Engineer's E-mail Address
City �State Zip elephone
CONTRACTOR'S NAME/COMPANY I p I_ ���-�./X Lic No. �— Class
Contractor's Address I I v v� Contractor's E-mail ddr
City State F Zip F Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. ,/�- V(/1- 1 ►/1(�0
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. cto 161
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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