HomeMy WebLinkAboutX2019-3907 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
F_ Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 4<
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Project Address (Not address) F_ Flood F_ Fire f Liq F Landslide rN/A Floor Suite No
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Description of Work
Use Const Type
# Stories #Units (if Res)
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Valuation
Material/Laa bor
New/Add SFRemodel SFF— Garage/New/Add F—
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
City �r o �. '� Stater
Zip ja66c Telephone
APPLICANT'S NAME Last U��x.r.55.n
First 5
Applicant'sAddress,s
Applicant's E-mail Address
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City State 46
Zip (1/� 730 i Telephone
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ARCHITECT/DESIGNER'S NAME Last F—
First F_ Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City State ��
Zip Telephone
ENGINEER'S NAME Last 9� (�
First a� S 1 ,, Lic. No. 5- 27b5
Engineer's Address
Engineers E-mail Address
1711Y Gt/• k,-k11% AL e , 107
City Fi5Eie, State
Zip r) f 7 Telephone �7/K e 7 11q:5
CONTRACTOR'S NAME/COMPANY Li No. / Class
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Contracttoorrs Address
Contractor's E-mail Address
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City Ftz� - �7_9 _ State 6/�-
Zip / ?3� Telephone t S J);Zj".�- 2�/Z p
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.2
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $