HomeMy WebLinkAboutX2019-3908 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o�E'°' x
F_Comm'I r" Residential City of Newport Beach - Building Division '�'
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood r" Fire F Liq Landslide -_N/A Floor Suite No
Description of Work
Use [_ ConstType F_
# Stories # Units (if Res)F—
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Valuation $
Material/Labor
New/AddSFs Remodel SF Garage/New/Add—
OWNER'S NAME Last First
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Owner's Address Owner's E-mail Address
City State e14 Zip i21 `iE;Ci TelephoneF_
APPLICANT'S NAME Last ���First Zs_
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last �— First F Lic. No. F—
Architect/Designer's Address Architect/Designer's E-mail Address
City I State �— Zip Telephoned
ENGINEER'S NAME Last Y� First n .� . Lic No.
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Engineer's Address Engineer's E-mail Address
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City State I (✓�k Zip `3266-% Telephone/y�) C�-c�.7_
CONTRACTOR'S NAME/COMPANY aIIS �% IJ Lic No. q v Class
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Contractor's Address Contractor's E-mail Address
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City •��icLr,+=vn�.r State L- Zip �Telephone (':j—
SETBACKS REAR SETBACKS FRONT PERMIT NO. Z�IN-
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $