HomeMy WebLinkAboutX2019-3693 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
Comm] XResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
NT Building F_ Grading D 'age
F Elec f- Mech
Plum Cu Yd Cut Cu Yd Fin F
Project Address (Not mailing
address) Flood
�.. Fire (L Liq j Landslide �N/A Floor Suite No
Description of Work
Use Const Type r
-
F_Y
"
�j
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F—
# Stories! # Units (if Res);
Valuation $
New/AddSF� Remodel
SF Garage/New/Add
F`®
Material/Labor
OWNER'S NAME Last,
�� ii�LC�
First l' e� �, I ��
Owner's Address
Owner's E-mail Address
I`-�) L�`( 0--, P�V\
F___7___________
City
l' State L�
Zip Telephone ;
APPLICANT'S NAME Last
First fi
Applicant's Address
Applicant's E-mail Address
City I
State Zip F_ Telephone
ARCHITECT/DESIGNER'S NAME
Last Fir t Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
-
r0 �� � � "Ca , �
City
State (y'„ Zip (� ,/ U L'7 Telephone
ENGINEER'S NAME Last
First Lic. No.
Engineer's Address
Engineer's E-mail Address
City �
State Zip Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. Class
Contractor's Address
Contractor's E-mail Address
`I C(2- . SL
f
1.� � 1 � � 7 CJ ^rn� i� , 670A-(.
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City F �J' a
- --
State Zip Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �, ejC -7 b
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE s DEVELOPMENT NO
PLAN CHECK FEES $