HomeMy WebLinkAboutX2019-1695 - Permit ApplicationPrint Form Worksheet for Combo Building &Solar Permit Application oeoW�ge
Commit (- Residential City of Newport Beach - Building Division:
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_Building [_ Grading F-Drainage F- Elec F_ Mech f�um Cu Yd Cut l _ Cu Yd Fill
Project Address (Not mailing address) F Flood r- Fire F_ Liq F_ Landslide (-N/A Floor Suite No
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Description of Work
Use F— ConstTypeF—
# Stories7 #Units (if Res)
Valuation 5 ',rL/1
Material/Labor ),0,0Qa
Remodel SF
New/AddSFF /Add
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OWNER'S NAME Last �i t First �
Owner's Address
Owner's E-mail Address r
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City /v�W��� State 1 v�6 Zip q , n/1 Telephone—O
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APPLICANT'S NAME Last l� r yy�Ay4.- First
Applicant's Applicant's Address Applicant's E-mail Address
City— State ( \ Zip G1(� AQ� Telephone
ARCHITECT/DESIGNER'S NAME Last ;/ CC_ 0 G✓ �ha �,;r� Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address o
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City �— State r— Zip �— Telephoned
ENGINEER'S NAME Last Gt L--,, vk 'k First' j/'�/� Lic No. _, t `7C! Ld
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Engineer's Address Engineer's E-mail Address
City State — Zip �— Telephone F_
CONTRACTOR'S NAME/COMPANY ss WtC_ Q � i 0 Al Lic No. ,7 7
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Contractor's Address Contractor's E-mail Address
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�City `N� , State �(� ,cam Zip 62� Telephone ,(\ 9 `Q Y
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SETBACKS REAR SETBACKS FRONT PERMIT NO. X � g 1 `7 i b l 5
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. I7 _ Z�I
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $