HomeMy WebLinkAboutX2019-1471 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application (__J
WoReo I� l i,�Comm'I � Residential City of Newport Beach -Building Division gNOTE: PLAN CHECK FEES DUE ATTIME OF SUB AL ".0."
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Project Address (Not mailing address) F_ Flood
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Description of�Work
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� #Units (if Res)
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Valuation $
Material/Labor
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OWNER'S NAME Last ��`�>`C�
First
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last �����;. First ''�.� Lic. No. ?, .j�Lf
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Architect/Designer's Address
Architect/Designer's E-mail Address
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City%'( State
Zip Telephone��,�?/�
ENGINEER'S NAME Last �
First F r� Lic. No.1
Engineer's Address
Engineer's E-mail Address
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Zip ` 1'� 2 Telephone Clip-- ��Z - Lo Z-�Z-
CONTRACTOR'S NAME/COMPANY
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Contractor's Address
Contractor's E-mail Address
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Zip i7i- Telephone lin
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 7,0 1 Q - I1 l
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. ton - W\ l
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ ZY��