HomeMy WebLinkAboutX2019-4170 - Permit ApplicationJ y v I q s ! P 4 _
Part Form Worksheet for Combo Building & Solar Permit Application nIn
Comm'IResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building ❑Grading
❑Drainage ❑Elec ❑Mech ❑Plum CuYdCut l I CuYdFill l
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ LandslideJ❑N/A Floor Suite No
41
Description of Work
Use ConstType C
# Stories❑ # Units (if Res)❑
7 A e
. , p i
n
Valuation �D yy,l
Material/Labor
New/Add SF
Remodel SF �—� Garage/New/Add
OWNER'S NAME_
Last First Q �
Owner's Address
Owner's E-mail Address
e
City
State Zip Telephone
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
"1►
4
-dl
394
City
State Zip Telephone
r
ARCHITECT/DESIGNER'S NAME Last First --�
® Lic. No.
Architect/Designer's Address
(y'Ac Architect/Designer's E-mail Address
aAr-C2
City
State Zip Telephone J
ENGINEER'S NAME
Last , I First Lic. No _i.
Engineer's Address
Engineer's E-mail Address
City?W_
State Cf'1" Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address
Contractor's E-mail Address
�
City
,State; Zi �. I Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. — �17
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USEZONE
DEVELOPMENT NO PLAN CHECK FEES $