HomeMy WebLinkAboutX2019-1082 - Permit Applicationy,-oiq —101'2— q q 4 vACA Ua1u (, a
Print Form Worksheet for Combo Building & Solar Permit Application rEW�R.
r Comm'I F— Residential City of Newport Beach - Building Division fq„
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding F_ Grading (—"Drainage 17Elec j—:_Mech [—Plum cuvdCut � CuvdFillF7/20 ?
Project Address (Not mailing address) T_ Flood F Fire r` Liq f- Landslide A Floor Suite No
Description of Work
Use � I Const Type
# Storiese� #Units (if Res) F
_
-
Valuation$
Material/Labor
New/Add SF � Remodel SF��
Garage/New/Add
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City State ��' Zip I Telephoner.
APPLICANT'S NAME Last I
First
Applicant's Address
Applicant's E-mail Address '
city _... -. _ State
Zip Telephone
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
® I
._
Architect/Designer's Address
ArchitectlDesigner's E-mail Address 4004 di Li
city � _ � State F_�
—
Zip F_ Telephone
ENGINEER'S NAME Last
First Lic No. F_
Engineer's Address
Engineer's E-mail Address
City State F_J
Zip I Telephone F_
CONTRACTOR'S NAME/COMPANY ��
Lic. No. F ClassF
Contractor's Address
Contractor's E-mail Address
City �. State
Zip Telephonel
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USEZONE DEVELOPMENT NO
PLAN CHECK FEES $