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HomeMy WebLinkAboutX2019-2574 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application o4�W-gym j Comm'I f4esidential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Building F_GradingF-Drainage F_Elec F_Mech Plum Cu vd cut Cu Yd Fill Project Address (Not mailing address) F_ Flood F_ Fire r Liq F_ Landslide r_N/A Floor Suite No �/, 1, % . 1 s ✓i �f _ S Description of Work Use Const Type # Stories # Units (if Res)F' - Valuation $ New/Add SFF— Remodel SFF Garage/New/Add F— Material/Labor OWNER'S NAME Last First Owner's Address Owner's E-mail Address L/av *L � - 4NJLjlif City t /�Z � C State Zip Cl� Telephone ��/ �S ZO6 APPLICANT'S NAME Last First Applicant's Address Applicant's E-mail Address City L .mot _/L� - _ State I v� Zip -%� � Telephone 6/lr ARCHITECT/DESIGNER'S NAME Last T�[�Dri/�1 First �} Y/«/L<? Lic No. Architect/Designees Address Architect/Designees E-mail Address City I State 7 Zip F_ TelephoneF ENGINEER'S NAME Last T7LcXJ/�X� First D��� Lic. No. e Engineer's Address Engineer's E-mail Address d City ��/( `S State C/`i 9ae�� -7/ , Zip Telephone ?-9&7-J , CONTRACTOR'S NAME/COMPANY Lic. No. �— Class Contractor's Address Contractor's E-mail Address City Sate Zip F— Telephone— SETBACKS REAR SETBACKS FRONT PERMIT NO. qo II-vnl SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. l B lq USE ZONE DEVELOPMENT NO PLAN CHECK FEES $