HomeMy WebLinkAboutX2019-1793 - Permit ApplicationPrint Form Worksheet for Combo ilding olar Permit Application o�=01
F
City of Newport Beach - Building Division 1
Comm" Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ��® 11 \u c" -.,
f—Building F, Grading
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FDrainage F_Elec F_Mech PE'um Cu Yd Cutl Cu Yd Flus
Project Address (Not mailing address) F_ Flood F`"` Fire F Liq Landslide [N/A Floor Suite Nc
Description of Work
Use Const Type s
3
# Stories # Units (if Res)[—
fgedd
At Y41
New/Add SF
' Valuation $61 1
Remodel SF Ga— — - Material/LaboOP
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
City
State F Zip Telephones.
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City
State F_. Zip F_ TelephoneF�
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F��
Architect/Designer's Address
Arch itect/Designer's E-mail Address
City I
State F_ .Zip F— TelephoneF_.
ENGINEER'S NAME
Last FirstF_ Lic. Nasi
Engineer's Address '
Engineer's E-mail Address
City
State F_ Zip I TelephoneF�
CONTRACTOR'S NAME/COMPANY
Lic. No. �� Class
Contractor's Address
Contractor's E-mail Address
city
State Zip TelephoneF�
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE nFVFLOPMENT NO.. PLAN CHECK FEES $