HomeMy WebLinkAboutX2019-0794 - Permit ApplicationPrint Form I worKsneet for c:omuo building & solar Permit Application
F_ Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building r Grading j-Drainage F_ Elec F_Mech
r Plum CuydCut r CuYdFill r
Project Address (Not mailing address) F_ Flood r Fire F_ Liq r Landslide F_N/A Floor Suite No
Description of Work
Use. Const Type
_L I
# Stori # Units (if Res)F_
aluatio r
Material/La or �1
New/Add SFF--- Remodel SF ;G ,_� Garage/New/Add
Ji
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
City State
Zip Telephone C _ C%'O/E�Aj
APPLICANT'S NAME Last fy° ��1�
First��
Applicant's Address
Applicant's E-mail Address
7
City p�j � State L
Zip ; � _ , Telephone 'r 2
ARCHITECT/DESIGNER'S NAME Last hq First —Lic. No. F—
Architect/Designees Address
Architect/Designer's E-mail Address
r
City Gn f�State G�
Zip f�y�7 Telephone
ENGINEER'S NAME Last
First F Lic. No f
Engineer's Address
Engineer's E-mail Address
City State F—
Zip I — Telephoner
CONTRACTOR'S NAME/COMPANY
Lic. No. r— Class
Contractor's Address
Contractors E-mail Address
City I State F_
Zip r Telephoner —
SETBACKS REAR SETBACKS FRONT -,,.a
- PERMIT NO. x -07W,1
SETBACKS LEFT SETBACKS RIGHT V `�
,..` "b`ty�'-'(-=/1�--�►'� PLAN CHECK NO. ^r ✓ I
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $