HomeMy WebLinkAboutX2019-3915 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Applicationre°Ar
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Comm'I Residential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
("Building f— Grading (`Drainage F_ Elec r Mech j Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) J_ Flood ( Fire F- Liq r- Landslide -_N/A Floor Suite No
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Description of Work
Use I— ConstType
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it StoriesF_ # Units (if Res)[_
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Valuation $
Material/Labor Sf�
New/Add SFF— Remodel SFF
Garage/New/Add �—
OWNER'S NAMELast First � lU.��e.¢._ y
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Owner's Address
Owner's
Owner's E-mail Address
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city �' State Zip �O Telephoner —
APPLICANT'S NAME Last.
First (i5
Applicant's Address
Applicants E-mail Address
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ARCHITECT/DESIGNER'S NAME Last
First F_ Lic. No. F_
Architect/Designer's Address
Architect/Designees E-mail Address
City State F_
Zip I TelephoneF_
ENGINEER'S NAME Last— _
First L.�i�9 , Lic No.r' 00-2 H6
Engineer's Address
Engineer's E-mail Address
City �` State z�6
Zip f�2��TTelephone �� 9 --2 f/�5
CONTRACTOR'S NAME/COMPANY Lic No. F9L(( f/c Class
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Contractor's Address
Contrractor's E-mail Address
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City (�r�cR.rn ✓�J� State
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. X a I q
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $