HomeMy WebLinkAboutX2019-1213 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'] V, Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Cu Yd Fill
Address (Not mailing address) F Flood F_ Fire [_ Liq F_ Landslide FN/A Floor Site No
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on of Work
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,n A ��i # Stories #Units (if Res)s
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New/Add SFI— Remodel SF —Valuation $ Fo�Garage/New/Add
�.— Material/Labor
OWNER'S NAME Last
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Owner's Address / Owner's E-mail Address
City (brla a� state Zip 'l QS Telephon %y q a��//
APPLICANT'S NAME Last
Pr. o� First , t_ i
Applicant's Address Applican 's E-mail Address
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City 04cc etc A State Fc;�_ Zip '� Telephone 9 � 6 5D
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address ot40
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City j5� �a State I/ ,L
First Chly S Lic. No. C- V� 3
Architect/Designer's E-ma'I Address
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ENGINEER'S NAME Last
ans aG t First r q Lic No.F_
Engineer's Address Engineer's E-mail Addres
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City R•^�" �a State— ZipFqa 70 Telephone 719
CONTRACTOR'S NAME/COMPANY I
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Contractor's Address Contractor's E-mail � S`1Ct. PLI_7 S.
Zip ` Telephone�/cr ]/g-OdCity State a3 C /
SETBACKS REAR SETBACKS FRONT PERMIT NO. 1�' \
SETBACKS LEFT SETBACKS RIGHT �y� PLAN CHECK NO. 0
USE ZONE DEVELOPMENT NO .!/'bC 104Q PLAN CHECK FEES $