HomeMy WebLinkAboutX2019-3006 - Permit ApplicationPrint Form _ Worksheet for Combo Building & Solar Permit Application d _7110
City of Newport Beach - Building Division
❑ Comm'I ❑ Residential a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
c�
❑Building El Grading ❑Drainage ❑Elec ❑Meth ❑Plum CuvdCut
171 CuvdFill
Project Address (Not mailing address) ❑ Flood _, Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
3v� NM1{vLQ � 0
Description of Work Use Const Type
l# Stories❑ # Units (if Res)E]
Ire Gii� SSG
Valuation $
New/Add SF Remodel SF _ Garage/New/Add Material/Labor 3ap�
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State Zip [:7:77] Telephoned
APPLICANT'S NAME Last I First
Applicant's Address
City _ State L�
Applicant's E-mail Address
Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address
Cit' State
ArchitecUDesigner's E-mail Address
Zip Telephoned
ENGINEER'S NAME Last First � Lic. No.
Engineer's Address
City State
Engineer's E-mail Address
Zip Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. [� Class
Contractor's Address
City State
SETBACKS REAR
SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
USE ZONE _
DEVELOPMENT NO
Contractor's E-mail Address
Zip Telephoned
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $