HomeMy WebLinkAboutX2019-3469 - Permit Application (3)Print Form Worksheet for Combo Building $ Solar Permit Application
City of Newport Beach - Building Division
Comr I Jt/Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding F_ Grading [—DrainageElec j Mech
Plum Cu vd cut Cu Yd Fill F
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Project Address (Not mailing address) F Flood
Fire (-' Liq F_ Landslide FN/A Floor Suite No
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i ti� rE S QA U N .
Description of Work
Use v I�onstType l r�
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# Stories # Units (if Res)F
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Material/La o-=132,
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New/Add SFF_ Remodel SF Garage/New/Add
OWNER'S NAME Last r---
First
Owner's Address
Owner's E-mail Address ��� 0r I
City I State F_
Zip F— Telephoned
APPLICANT'S NAME Last �,
First )%
Applicant's Address
Applicant's E-mail Address
r /
t
City `. ,� 1J� State �/f
Zip �+T�l 1 �; Telephone - ^
F
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F_
Zip F— TelephoneF_
ENGINEER'S NAME Last
First F Lic. No.F
Engineer's Address
Engineer's E-mail Address
City �— State I
Zip F TelephoneF_
CONTRACTOR'S NAME/COMPANY
Lic. No. F ClassF
Contractor's Address
Contractor's E-mail Address
City State
Zip �— TelephoneF(1��
SETBACKS FRONT
�71 ,� r
PERMIT NO. XpID ` 1 - L \te0
SETBACKS REAR
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $