HomeMy WebLinkAboutPV2019-112 - Permit ApplicationPnafi Form Worksheet for Combo Buildingr u it tq - (` 2
COM I &`Solar Permit Application
Residential City of Newport Beach - Building Division z
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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❑ Liq [� Landslide UN/A Floor _I
Suite No
Description of Work
use Const Type
#Stories❑, # Units (if Res[
_7 SFF Remodel SF
Garage/New/Add �� Valuation $
OWNER'S NAME Material/Labor
Last
Owner's Address First
.Owner's E-mail Address
City
State
APPLICANT'S NAME Zip Telephone
Last
Applicants Address First
Applicant'sE-mailAddress
City -
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ARCHITECT/DESIGNER'S NAME .State Zip Telephone)
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ArchitecVDesigner'sAddress First)
Lic No.
Architect/Designer's E-mail Address
City
State Zip
Telephone /-
ENGINEER'S NAME
Lash—
Engineer's AddreFirst
ss - f Lic. No.
Engineer's E-mail dr s'
fill
State �� Zip -
Telephone
CONTRACTOR'S NAME/COMPANYI�
f0 6ail L� � �
� �GYsrt ( �A f � Lic. No. U`�y�s class
Contractor's Address
�qo W. � Contractor's E-mail Address ";�
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State. C/-�' -J Zip 1 Gil Cl Telephone
S BACKS REAR SETBACKS FRON
SETBA KS LEFT y PERMIT NO.
SETBACKS RIGH
LSE ZONE PLAN CHECK NO.
DEVELOPMENT Nk e•
PLAN CHECK FEES $