HomeMy WebLinkAboutX2019-1608 - Permit ApplicationPrint Form � 9 PP @16_50
ormorksheet for Combo Buildin &Solar Permit A lication
F- Comm'I j- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_Building Grading
F-Drainage (-Elec F_Mech F_ Plum cuYdCut CuYdFill F
Project Address (Notmailing address)Flood F_ Fire F_ Liq r Landslide Floor Suite No
-Dice F_ F_
Description of Work
Use I— Const Type
# StoriesF # Units (if Res)[
Valuation $
Material/Labor
New/Add SIF �—
Remodel SF F` Garage/New/Add F—
OWNER'S NAME
Last �— First
Owner's Address
Owner's E-mail Address
City F—
� State F Zip r— Telephoned
APPLICANT'S NAME
Last F First
Applicant's Address
Applicant's E-mail Address
City F
State F Zip [_ TelephoneF_
ARCHITECT/DESIGNER'S NAME Last First F_ Lic. No.
Architec Address
_ Architect/Designer's E-mail Address
City F
State Zip F Telephone[
ENGINEER'S NAME
Last �� � First F— Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City
State F_ Zip �� Telephone[ —
CONTRACTOR'S NAME/COMPANY . `�� Lic No. lVj i Class
Contractor's Address
Contractor's E-mal Address
city /!"
StateFc — Zip Telephons,
01
TBACKS REAR
SETBACKS FRONT PERMIT NO.� _-- -
SET S LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $ /. s