HomeMy WebLinkAboutX2019-1635 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o4aPrComm'I (S( 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 F_ Fire XLiq F- Landslide FN/A Floor Suite No
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Description of Work
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New/Add SF� Remodel SF �� Gara a/New/Add
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Valuation f� ZpQ
Material/Labor
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OWNER'S NAME Last
IQ o�,�,_ 1 First
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Owner's Address
Owner's E-mail Address
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City "C�o
State C �.). Zip O(� Telephone��c 5
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APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City
State F--- Zip F Telephoned
ARCHITECT/DESIGNER'S NAME
Last First I Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State- F_ Zip F_� TelephorieF---- --
ENGINEER'S NAME Last
First F_ Lic No.F_
Engineer's Address
Engineer's E-mail Address
City �
State I Zip F_ Telephoned
CONTRACTOR'S NAME/COMPANY
0 JoUt j _ Lic. No. F Class F—
Contractor's Address
Contractor's E-mail Address
City �
State F_ Zip F_ Telephonel�
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SETBACKS REAR
SETBACKS FRONT ( PERMIT N0.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. I(,?- do
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $