HomeMy WebLinkAboutX2019-1871 - Permit ApplicationPrint, Form .:°
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division Aso M
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL /1
Building r Grading
F -Drainage F_Elec F_ Mech r Plum cuvdCut l cuvdFill F_
Project Address (Not mailing address) r Flood F_ Fire F_ Liq j-"' Lalndslide rN/A Floor Suite No
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Description of Work
Use Const Type
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# StoriesF # Units (if Res) '
1.
Valuation $ [TO
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Material/Labor (/
New/Add SFF
Remodel SF� Garage/New/Add �'
OWNER'S NAME
Last
LasY��L� M/ �zy� First
Owner's Address
Owner's E-mail Address
City
a//. State �(' Zip Telephoned
APPLICANTS NAME
Last lj,44[% First -=MMA1
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Applicant's Address
Applicant's E-mail Address
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City G may
', State I cpc Zip I!W Telephone 1ti 8sa -Qg'S4e)
ARCHITECTII/D�ESIIG-NEER✓'S NAME Last �', First F_F_
Lic. No.
Architect/Designer's Address
Architect/Designees E-mail Address
City I_,_.
State F_ Zip FTelephone[
ENGINEER'S NAME
Last First F_', Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State F Zip r Telephonel-----_'�,
CONTRACTOR'S NAME/COMPANY �� /� G� Lic. No. O Class (, ;6 -
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Contractor's Address
Contractor's E-mail Address
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City C
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State � - zip _ll M2 Telephone�7 <By
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $
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