HomeMy WebLinkAboutX2019-3911 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application 6,EW e.
F Comm'I F_Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �f
(`Building r Grading [`Drainage F_ Elec r Mech
r Plum Cu vd Cut Cu Yd Fill
Project Address (Not mailing address) I- Flood F_ Fire r- Liq I" Landslide f N/A Floor Suite No
Descriptions of Work
Use F—ConstType
# Stories #Units (if Res)
SEy.�s r 5�z�s
r
Valuation $
Material/Labor a SIC
New/Add SIF Remodel SF F— Garage/New/Add r
OWNER'S NAME Last-
44-Cl- First
Owner's Address
Owner's E-mail Address
Owners
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City �jState G��.
Zip i ao Telephone -.....
APPLICANT'S NAME Last ��`
First 64,2.
Applicant's Address
Applicant's E-mail Address
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City G✓State
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Telephone�/p517, v
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 59_,Z
First �! , Lic. No.
Engineer's Address
Engineer's E-mail Address
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City ��� State
Zip (i.� _, TelephoneV7r 7,l1y5
CONTRACTOR'S NAME/COMPANY Lic No. I �)t/(g/& Class
1J
Contractor's Address
Contractor's E-mail Address
cityCnr ` _ State GJ
Zip 7 Telephone�y�/ I j5�5 r2J
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $