HomeMy WebLinkAboutPV2019-199 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
[1 Comm1 JVResidential City of Newport Beach - Building Division _
NOTE:. PLAN. CHECK FEES DUE AT TIME OF SUBMITTAL
[]Building ❑ Grading ❑Drainage ❑ Elec ❑ MechPlum
❑. Cu Yd Cut =
Cu Yd Fill
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq [) Landslide [N/A Floor Suite No
Description of Work--------
�1; _ I Use Const Type
G � � g°
#Stories/ #lUnits(if Res)
New/Add SF Remodel SF� /Garage/New/Add Valuation $
Material/Labor
OWNER'S NAME Last Q
First � qY
Owner's Address
Owner's E-mail Address
City State
ZIP Telephone71
APPLICANT'S NAME Last
� First:
Applicant's Address _ Applicant's E-mail Address
73City =r State Zi :� Tel one
ARCHITECT/DESIGNER'S NAME Last
First Lic. No:
Architect/Designer's Address Architect/Designees E-mail Address
City -StateC
zip
Telephone)
ENGINEER'S NAME Last First—�
Lic. No.
Engineer's Address Engineer's E-mail Address%
.City I State Zip t Telephoned
CONTRACTOR'S NAME/COMPANY ie jet I Lic. No. ✓� i l Class �- �
Contractor's Address
ye" 7 Contractor's E-mail Address
City °1'�,; ��. - I State I ZiPy J Telephone I.
SETBACKS REAR SETBACKS FRONT PERMIT NO. _tiGq • - i-
SETBACKS LEFT SETBACKS RIGHT PLAN. CHECK NO. 2 j'"?j'?,C a
USEZONE DEVELOPMENT NO PLAN CHECK FEES $ --�