HomeMy WebLinkAboutX2019-1921 - Permit ApplicationPrint Form ) Worksheet for Combo Building & Solar Permit Applicatio
""City of Newport Beach - Building Division (�
�_. Comm'I f-,Z' Residential q
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTKK� °<Fo
F_ Building Grading F—Drainage F_ Elec F_ Mech
Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing
address) f Flood F_ F' e q ndslide I_N/A Floor Suite No
Description of Work
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9
Use F Const Type
# Stories # Units (if Res)F
7
3 L� e ' ActAIIJ r
,� At " '0
" ! tJ Ca f Ni1rry
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NewYAdd SF Remodel SF Garage/New/Add
F
Valuation $ q C)����
Material/Labor 1
OWNER'S NAME Last
First CL '�() AJ
Owner's Address
Owner's E-mail Address
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City toew G,i J, �-
State A_ Zip ��,� � � Telephone�� ys-� �®�,� -
APPLICANT'S NAME Last �ol�is
First i- t-4
Applicant's Address
Applicant's E-mail Address
'A !fit
I
City I
State F Zip
Telephone
ARCHITECT/DESIGNER'S NAME
Last
First I Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F zip
F Telephoned
ENGINEER'S NAME Last
V'/0fV (�
First FNtO
�� iN Lic. No.r— 'a
Engineer's Address
Engineer's E-mail Address
City f fl-N
State zip
TZ 70 ! Telephone '.. 7 >
CONTRACTOR'S NAME/COMPANY
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Lic. No. Class
Contractor's Address
Contractor's E-mail Address
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City F
State zip
I Telephone
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $