HomeMy WebLinkAboutX2019-2736 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application 10
r Comm'] Residential City of Newport Beach - Building Division � g
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTALS?'
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Building r Grading rDrainage r Elec r Mech (- Plur', Cu ydcutF_ Cu Yd Fill F_
Project Address (Not mailing address) F_ Flood f Fire r Liq r Landslide f N/A Floor Suite No
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Description of Work x
Use Const Type F—
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# Stories # Units (if Res)F—
Soo �p aw r oE- l mr
Valuation $
Material/Labor I �/
New/Add SF �— Remodel SF �— Garage/New/Add F—
OWNER'S NAME Last First 1jPN�E WOE
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Owner's Address Owner's E-mail Address
City EW l-,2-T &E/4'CAr State Zip Z b ZV Telephone 310 - 4 -1 - cis t
APPLICANT'S NAME Last First h
Applicant's Address Applicant's E-mail Address
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City ` (�orJ State F Cep Zip if�3 1 Telephone.-r t � q g Z_
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ARCHITECT/DESIGNER'S NAME Last
fFurst �—
re,hpP) Lic. No.1�l.QZ'}lt
Architect/Designer's Address Architect/Designer's E-mail Address G - z
City State F— Zip I— Telephoned
ENGINEER'S NAME Last �-r� p First 5,.1} y Z • j Lic. No. S L Z,
Engineer's Address Engineer's E-mail Address
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City T_e %Ae"LY% State Zip aT,Telephone �^) _ 6 00 DO 3,2
CONTRACTOR'S NAME/COMPANY E y � �5w Lic. No. 5 �� Class
Contractor's Address Contractor's E-mail Address
City �—
� � j)�/•j State ZiP Telephone 7f� j/j �
SETBACKS REAR SETBACKS FRONT PERMIT NO.i�%`a•
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �ij 20
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $