HomeMy WebLinkAboutX2019-2079 - Permit ApplicationPrint Form � Worksheet for Combo Building &Solar Perm
it Application of e
Cityof Newport Beach - Buildin Division Comm'I #/ Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBUc`
Building i- Grading F-Drainage a Elec i— o.+
Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailingaddress F Flood �
) Fire (-' Liq � Landslide �N/A Floor Suite No
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Description of Work
Use ConstType F_
# StoriesF # Units (if Res)
Valuation $
Material/Labor
New/Add SFF—i Remodel SFF — Garage/New/Add —'
OWNER'S NAME Last rc �� L First
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Owner's Address Owner's E-mail Address
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City - tf- -- - -- - State G/}' ZiP -? Z Telephone 112 7t�
APPLICANT'S NAME Last First
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Applicant's Address Applicant's E-mail Address
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City tJ� State ,P
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Ll C /g Zip L��j) Telephone '71
ARCHITECT/DESIGNER'S NAME Last �/ r First -lf((/ Lic. No. 2Z 3 }
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Architect/Designer's ner's Address
g Architecl/Designer s E�
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City 'f� � State r/j, Zip "(,( Telephone kW
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ENGINEER'S NAME Last First F_ Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State F Zip TelephoneF
CONTRACTOR'S NAME/COMPANY - 1 ! C Lic No. �j 23 Cj Class irb
Contractor's Address Contractor's E-mail Address
City /l /v/% O1 N State Fo-' Zip Telephone 7//, el Z'76/7t
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. )(Z-01 t/ _ Z077
PLAN CHECK NO.
PLAN CHECK FEES $