HomeMy WebLinkAboutX2019-3909 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding rGrading F-Drainage f—Elec rMech FPlum cuvdCut curdFill
Project Address (Not mailing address) f Flood F` Fire F_ Liq F Landslide FN/A Floor Suite No
of Work
New/Add SFI Remodel SFF— Garage/New/Addl
Use F— ConstType
# Stories[— # Units (if Res)[_
Valuation $
Material/Labor
OWNER'S NAME Last First
Owner's Address O / Owner's E-mail Address
_.--
City r�� State I 4�4� Zip C� TelephoneF_
APPLICANT'S NAME Last
Applicant's Address
City �� State
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
First
Applicant's E-mail Address
Zip `�/`�J Telephone /'CAS/�,. xv;20
First Lic. No. F_
Architect/Designer's E-mail Address
City State �� Zip Telephone F_
ENGINEER'S NAME Last i First /'�, '1� Lic No.
5 alk27�
Engineer's Address Engineer's E-mail Address
city �:� State 6?14 Zip iL67 Telephone 7// O O c3 -� e fjG1s'
CONTRACTOR'S NAME/COMPANY
s Jn Lic No. Class
Coonntrractyor's Address Contractor's E-mail Address
[V/si lr�SI�.-5i
City �� � `� � State G 7 Zip Telephone , s4 ) ;z�f, -;zL/ v
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO. )(2 01
PLAN CHECK N0.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $