HomeMy WebLinkAboutX2019-2204 - Permit ApplicationPrint Form-1 Worksheet for Combo Building & Solar Permit Application oF�E °Rre
comm" �i Residential City of Newport Beach - Building Division p
1� NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) ❑ Flood [I Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
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Description of Work
Use 1 ConstT e
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# Storied ! # Units (if Res)C
Valuation $
Material/Labor
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New/Add SF Remodel SF Garage/New/Add
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OWNER'SNAME Last QA-uz C�
Owner's Address
Owner's E-mail Address
City . I State
Zip Telephoned.
APPLICANT'S NAME Last �1M
V
i First j(
Applicant's Address
Applicant's E-mail Address
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Zip -� Telephone py�s-00%5 c
ARCHITECT/DESIGNER'S NAME Last
First
� Lic. No. F—-
Architect/Designer's Address
Architect/Designer's E-mail Address
City i State
Zip r Telephone
ENGINEER'S NAME Last
I First I l 'Y V `' '.. Lic. No._—'_
Engineer's Address
Engineer's E-mail Address
City _ _ State '(�% ,,:.
Zip Telephone2C�.
CONTRACTOR'S NAME/COMPANYVL �U� b� `I
l�Coonntractt�or's
.. , jfN �c. No.�(� %��7 J Class !3 —
Contractor's Address
E-mail Address
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City State1
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Zip L�E�� Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 1515— 1,L)IC(
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $