HomeMy WebLinkAboutX2019-3134 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application of ` °„'e
r Comm'I Residential City of Newport Beach - Building Division V)q
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F Flood F_ Fire F; Liq ,`Landslide r_N/A Floor Suite No
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Description of Work
Use F' ConstType
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# Stories', # Units (if Res)
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-Valuation $
Material/Laho
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Garage/New/Add F
OWNER'S NAME Last
I First
Owner's Address
Owner's E-mail Address
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City 3 State F_,_ Zip Telephon jyq (�7 $— rlo-7
APPLICANT'S NAME Last i�c7(1.�—J
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Applicant's Address
Applicant's E-mail Address
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City �b(i--per U.�oA State ���i
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Zip $(p , Telepho( �i,`-t�'�J�q
ARCHITECT/DESIGNER'S NAME Last •V a _ �—
2r�1 -, First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip F__I Telephoned—,
ENGINEER'S NAME 1�t ► 1 1 Last
. First —. Lic. No.F_
Engineer's Address
Engineer's E-mail Address
City State F_—
Zip F_, Telephoned —
CONTRACTOR'S NAME/COMPANY / A
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- Lic. No. Class
Contractor's Address
E-mail Address
City I State
Zip F— Telephoner A
SETBACKS REAR S_/ SETBACKS FRONT
PERMIT NO. xe?6 1y 1a�
SETBACKS LEFT O / SETBACKS RIGHT
PLAN CHECK NO. ''���
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $