HomeMy WebLinkAboutX2019-0331 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
mm'I I Firssidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
ltuuilding I Grading (—Drainage F_Elec Mech
F_Plum CuvdCut I CuYdFill l
Project Address (Not mailing address) f— Flood
F- Fire r Liq r Landslide (—N/A Floor Suite No
Description of Work l/Y/ iY/
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New/Add SF Remodel SF F- Garage/New/Add
OWNER'S NAME Last I/ �C/ /�-v�V
0, First
Owner's Address
Owner's E-mail Address
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City State
Zip r— Telephone��
APPLICANT'S NAME Last
Firstl A
ApplicaanVs Address
Applicant's E-mail Address
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Zip 2/j�p2 Telephone �� c� •tjCL�4
ARCHITECT/DESIGNER'S NAME Last I First Lic. N 4--�Q/2 `J
ArchitectIDesigner's Address
ArchitecUDesigner's E-mail Address
City State �
Zip ! Telephoner
ENGINEER'S NAME Last 1
r
First No.
! Lic.
Engineer's Address
Engineer's E-mail Address
I
City I State F-
Zip ! Telephoner_
CONTRACTOR'S NAME/COMPANY n' Lic. No. �/ Class`
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Contractors Addressp
Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. ZQ 11- Q7j31
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
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PLAN CHECK FEES $ 1954
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