HomeMy WebLinkAboutX2019-3731 - Permit Application (2)�C2t�G`V3�31
Worksheet for Combo Building & Solar Permit Application
❑ Comm'I ❑ Residential
❑Building ❑ Grading
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
OWNER'S NAME Last
Owner's Address
City
APPLICANT'S NAME Last
Mech El Plum Cu Yd Cut F-7 Cu Yd Fill
Flood RFIre ❑ Li ndslide ❑N/A Floor Suite No
f] E71 E71
Use I Const Type I
# Stories❑ # Units (if Res)❑
wner's E-mail Address
State Zip l� Telephone
Applicant's Address
City I State
First
Applicant's E-mail Address
Zip TelephoneF
ARCHITECT/DESIGNER'S NAME Last First
Architect/Designer's Address
City State
Architect/Designer's E-mail Address
Zip � Tplephone
Lic. No.
ENGINEER'S NAME Last First Lic. No.
Engineer's Address
City State
Engineer's E-mail Address
Zip 7 Telephoned
CONTRACTOR'S NAMEXOMPANY iJt K -z) f0� Lic. No. 3 ? Class
Contractor's Address t�` Contractor's E-mail Address
City � State ZipgfqoyTelephone
SE ACKS REAR
SETBACKS FRONT
tERMIT NO.
SETBAC LEFT
SETBACKS RIGHT
�k/)
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $