HomeMy WebLinkAboutX2019-4181 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application On,
r CoComm"r✓Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DtIF AT TinnF nF .ci irennirTni
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Project Address (Not mailing address) rFlood rl Fire n Liq r Landslide rN/A Floor Suite No
Description of Work
Use ConstType 1—
# StoriesF' #Units (if Resf_�
Valuation $ S
Material/Labor
New/Add SF >{-oo n `A'^Remodel
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SIF y-�V U1.0 l rage/New/Add —�,
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OWNER'S NAME
Firsts i C--C-
Owner's Address
Owner's E-mail Address
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City , Y,
State F'� Zip 9 ,y(, w Telephoned
APPLICANT'S NAME Last
� - -
� ; - L,� First ` 6—" Acam
Applicant's Address
Applicant's E-mail Address
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City
State Zip 5266a Telephone `,:i
ARCHITECT/DESIGNER'S NAME
Last p �.V}.`� �First ��Lic. �'�^�
No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City {'�
_ State �G'--{�, Zip 4)Zb &0 Telephone ,.
ENGINEER'S NAME Last
, First F Lic. No.F
Engineer's Address
Engineer's E-mail Address
City
State F Zip �—. Telephone[ —
CONTRACTOR'S NAME/COMPANY
w4_�_�r Lic. No. Class F
Contractor's Address
Contractor's E-mail Address
11 ° ro "cif-'-WJ tiW .,_r 0--�
City
State Zip "i_2b6 J Telephone 945 �J
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. z C) 5 -- Z,U)
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $