HomeMy WebLinkAboutPV2019-038 - Permit Applicationpvlotq - 031
PfrntForm, Worksheet for Combo Building & Solar Permit Application
r Comm'I' (� Residential City of Newport Beach Building Division_ f
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j'Building F_ Grading
F -Drainage 'F_ Elec FMech F—PlumCu yd cut Cu Yd Fill
Project Address (Not mailing address) F Flood f-- Fire r Liq F- Landslide 'rN/A Floor Suite No '
Description of Work
Use F_ Const Type
# Storiesr # Units (if Resf ,
Valuation $
Material/Labor
New/Add SFF--.�—' Remodel SFI--.-�_—_
Garage/New/Add F_
OWNER'S NAME
Last r -
First
` Owner's Address
' Owner's E-mail Address:
City :State F Zip f._...,-,._— Telephoner—
APPLICANTS NAME
Last
First
r Applicant's Address
' Applicant's E-mail Address
City
State F_
Zip:.-- Telephoner'-----
ARCHITECT/p�SIGNER'S NAME LastI--- - First - —f / , ) -- Lic. No. F—
Architect/Designer's
Address
V
Architect/Designer's E-mail Address
City
i State F—
Zip.f 7 Telephoner -._--J
ENGINEER'S NAME
Last
First F_Lic. No.F_
Engineer's' Address
- Engineers E-mail Address
.City
State F_
Zip;rTelephone�_�
ZTbNTRACTOR'S NAME/COMPANY
(7
Ld Lic. No. 176,90 Class e ib
�
Contractor's E-mail Address
!-Addrress'Coo�rntractor's
J�i C�unl @�swi✓"SewSalar-tom�J',
,City
State �—
Zip.. e 7 Telephone �! 77 i�l
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
-SETBACKS LEFT
SETBACKS RIGHT.
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK. FEES $ /