HomeMy WebLinkAboutX2019-2587 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit gnpyrle�tion
al City of Newport Beach - Building Division (" t
NOTE: PLAN CHECK FEES DUE AT TJM&OF St IRMiTTA
VBuilding F` Grading'�Drainage XElec F Mech
Project Address (Not mailing address) I— Flood
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Description of Work
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New/Add SF F_4U`� Remodel SF �
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OWNER'SNAME Last
Owner's Address
City/1a State
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APPLICANT'S NAME
Applicant's Address
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ARCHITECT/DESIGNER'S NAME
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Use I OIL
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# Stories # Un
Valuation $
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Material/Labor 5-Z�4
First lA"` t� �- )Mvo�--T—
Owner's E-mail Address
ZIP gc�6_3 Telephone
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Applicant's E-mail Address
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State Zip f? Telephoneto 70W
Last I _ _to '�7-
Architect/Designer's Address
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First I 6YAAKLic. No. i ( l qtJ
Architect/Designer's E-mail Address
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ZIP 44CI0 Telephone Ql/Q n�,(r 7oZZ
ENGINEER'S NAME Last I
`I`yT{�GC-(lIgq First Pa ed _. Lic No.
Engineer's Address Engineer's E-mail Address
City I State
ZIP i Telephone[�
CONTRACTOR'S NAME/COMPANY Lic. No, 1
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�-1 Class
Contractor's Address Contractor's E-mail Address
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city L_ t �K•c }\ State C5� Zip 72,4`f �, Telephoner7/V1Ct�K��
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SETBACKS REAR SETBACKS FRONT r PERMIT NO.
SETBACKS LEFT r ti
SETBACKS RIGHT y3 � CI PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $