HomeMy WebLinkAboutX2019-0461 - Permit Applicationa
Worksheet for Combo Building & Solar Permit Application
i Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding i Grading (-Drainage F-Elec F-Mech j Plum CurdCut s CuvdFill
Project Address (Not mailing
address) F- Flood F- Fire F- Liq F_ Landslide I N/A Floor Suite No
39 O
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Description of Work
Use I ConstType iF
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# Stories # Units (if Res)
Valuation $
Material/Labor)
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New/Add SFs Remodel SF �s-®-
Garage/New/Add F
OWNER'S NAME Last
First)
Owner's Address
Owner's E-mail Address
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City N >-7. ,.,-.i
1 State j t_D
Zip G� ��3 Telephone
APPLICANT'S NAME Last i-��
First
Applicant's Address
Applicant's E-mail Address
City
State (-
Zip F- Telephoned_
ARCHITECT/DESIGNER'S NAME
Last I L C B�
First rSFj E'v F=_ Lic. No.
ArchitecVDesigner's Address
Architect/Designer's E-mail Address
City
State
Zip Telephonei��
ENGINEER'S NAME Last I
First Lit. No.s��
Engineer's Address
Engineer's E-mail Address
City s�s
State F_
Zip �� Telephone(
CONTRACTOR'S NAME/COMPANY
! O-ryI Cpuy fYy CLwfP�c rb>ZS Lic. No. ICI $6 I'75 class,
Contractor's Address
Contractor's E-mail Address
(o i �Xc�CR woY
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City CO!•Loj+p
State r
Zip QZa82 Telephonel9� '�S 6304
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. X d C .I c, - L` LI C_
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. - , `I c - C cl
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $