HomeMy WebLinkAboutX2019-0416 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application sgwi
jComm'I ResidentialCity of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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Valuation$
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Material/Labor
OWNER'S NAME Last First �r�q
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last _ Fa\•C' _....... First
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last First �V1CKt Lic. No. CQo\2
Architect/Designer's Address Architect/Designer's E-mail Address
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City �i� . ,, Gv-lr.... %Cq6r% State Zip o\�� 3 Telephone
ENGINEER'S NAME Last �- First F Lic. No.�—'
Engineer's Address Engineer's E-mail Address
City — State F Zip F— TelephoneF—
CONTRACTOR'S NAME/COMPANY
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0,1Vt✓UrA Lic. No.
Contractor's Address Contractor's E-mail Address
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State C�— Zip 9'ZGz$' Telephone 9YOZ3-6
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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