HomeMy WebLinkAboutX2019-1549 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r- Comm'I F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F -Building 7Grading F -Drainage j-Elec F—Mech
r- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r- Flood r-- Fire f- Liq F- Landslide FN/A Floor Suite No
Description of Work
Use F ConstType F_
# Stories #Units (if Res)
p (
9
Valuation
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New/Add SF�� Remodel SFF Garage/New/Add 1
Material/Labor
OWNER'S NAME Last az L 11l First
s
Owner's Address
Owner's E-mail Address
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City �;'{; `�l}%' =t 1..� State �' Z-.
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Zip',:.' Telephone
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
State _
Zip Telephone
9by�t`Y �City v
ARCHITECT/DESIGNER'S NAME Last F—
� First F_ Lic. No. F_�
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
City F- State w
Zip �� Telephoned `...
ENGINEER'S NAME LastIItt\,`��/ ' First / Lic. No.
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Engineer's Address
Engineer's E-mail Address
City L._f'"f+�+ State ' /,,
Zip aat,� 1. Telephone a o A'
CONTRACTOR'S NAME/COMPANY y i C 4'
{ `i �; Lic. No. ass
a
i
Cont/9ractor's Address
Contractor's E-mail Address
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CityjL(y l`L]i State i L
Zip Telephone e ; t /
F712_e, 2
,.� SETBACKS REAR SETBACKS FRONT
PERMIT NO. -o„ iiUj �.11A.
-'SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
'E ZONE DEVELOPMENT NO
PLAN CHECK FEES $