HomeMy WebLinkAboutX2019-3989 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'I r Residential City of Newport Beach - Building Division e
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM V
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F�Building F` Grading
ITTAL
rtfY age F_ Elec F Mech F_
lUm Cu Yd Cut Cu Yd fill
Project Address (Not mailing address) r Flood F Fire F- Liq j- Landslide F_N/A Floor Suite No
Description of Work
Use ConstType �Y
toriesl # Units (if Res)r
New/AddSFF—
RemodelSF��
a ti0/S
Garage/Ne4 ial/La
r
OWNER'S NAME
Last I (l / `e� /
/.(l1 C J
First ��� P Y.y
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Owner's Address
Owner's E-mail Address
City /�/CI (� j% y�
L.PL `. State Zip F_ Telephone (1
APPLICANT'S NAME
Last`
First
Applicant's Address
Applicant's E-mail Address
City ��
� State �-
Zip F_ Telephone F—
ARCHITECT/DESIGNER'S NAME Last
First F_ Lic.
No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State
Zip �- TelephoneF—
ENGINEER'S NAME
Last F-
-
First F— Lic. No.F
Engineer's Address
Engineer's E-mail Address
City
State F
Zip �- TelephoneF-
CONTRACTOR'S NAMEXOMPANY
Lic. No. F— ClassF_
Contractor's Address
Contractor's E-mail Address '""Oh gin
City ���
State �-
Zip [_ Telephoned
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. -2,r-r 4-). '�
/
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $
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