HomeMy WebLinkAboutX2019-3277 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application QPR�
FComm" Residential City of Newport Beach- Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) f— Flood F_ Fire F— Liq C` Landslide (PI/A Floor Suite No
Description of Work
Use Const Type pj
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if Stories # Units (if Res)
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Valuation $
Material/Labor
New/Add SFRemodel SFF � Garage/New/Add
OWNER'S NAME Last �� First 7E:0K �
Owner's Address Owner's E-mail Address
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City � —y State Zip < Telephone ` of
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APPLICANT'S NAME Last �fL First
Applicant's Address Applicant's E-mail Address
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City ..--� ;.J (� State fcf/�,, Zip -IZC-46 Telephone C-Zl�_�2C�
ARCHITECT/DESIGNER'S NAME Last ��� First Lic. No. �"'7�U
Architect/Desiner's Address
9 Architect/Designer's E-mail Address
City _. _ 4 State Zip l_--....-- Telephone;ijQ- -Z
ENGINEER'S NAME Last t ��—�jZ First `2S9 � Lic.No.1
Engineer's Address Engineer's E-mail Address
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City r t(1��Lj Wil✓ State l y� Zip F9Sctl.2j Telephone ceC a —q
CONTRACTOR'S NAME/COMPANY Lic. No. F_ Class F_
Contractor's Address Contractor's E-mail Address
City State w. Zip �— Telephone��'
SETBACKS REAR - SETBACKS FRONT 20 PERMIT NO. o (q, 21
SETBACKS LEFT � � SETBACKS RIGHT 4 � PLAN CHECK NO.
USE ZONE �{.'�� DEVELOPMENT NO `D2yI .�Q PLAN CHECK FEES $ 5
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