HomeMy WebLinkAboutX2019-0582 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o,`'"
F_ Comm'I F-ResidentialCity of Newport Beach - Building Division 9
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_ Building FGrading
FDrainage F-Elec F_Mech
j-Plum Cu vd Cut Cu Yd Fill
Project dre 5 (NOt m iling address) [_ Flood
F- Fire f- Liq r- Landslide F_N/A Floor Suite No
Wt J�M!A
F F_
Description o Work
toUse
F—ConstType F—
# Stories # Units (if Res)[—
Q
New/Add SF
Remodel SF Gara a/New/Add
g I
Valuation a
Valuation $ or
OWNER'S NAME
Last ;�
,
First
Owner's Address
Owner's E-mail Address
City �
State ��
Zip �_ TelephoneF_
APPLICANT'S NAME
Last F_
First
Applicant's Address
Applicant's E-mail Address
City F—
State F_
Zip Telephone��
ARCHITECT/DESIGNER'S NAME Last F
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I�
State F—
Zip �— Telephoned
ENGINEER'S NAME
Last �—
First F_ Lic No.F—
Engineer's Address
Engineer's E-mail Address
City
ate F_
Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY
Lic No. F Class
Contractor's Address
t
Contractor's E-mail Address
City �
State ��
Zip F_ Telephoned
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. XTQ 19 -
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHEC
USE ZONE
DEVELOPMENT NO
PLAN CHEC ES $