HomeMy WebLinkAboutX2019-1303 - Permit Application (2)print Form Worksheet for Combo Building & Solar ermit Application 0
F' Comm'I F— Residential City of Newport Beach - Building Division (: a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �.J �<„°,°”
F—Building F_ Grading rDrainage F_Elec F—Mech PlumF_
Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) I— Flood F_ Fire r" Liq r— Landslide F_N/A Floor Suite No
Description of Work
Use �' Const Type
•� �J S _� � �7�� # Stories #Units (if Res)
New/AddSFF— Remodel SF Gr t) Valuation $
Garage/New/Add �` Material/Labor
OWNER'S NAME Last First 1'+ V"-65
Owners Address
_ .Owner's E-mail Address
City Ft� rP State Zip L"J
Telephone l6{ qc &q
APPLICANT'S NAME Last f — may` First
Applicants Address Applicant's E-mail Address
.CityWJKfW( A( .State Zip 's TelephoneF If
ARCHITECT/DESIGNER'S NAME Last
First Lic.No.Ic–
Architect/Designer's Address Are hitect/Designer s E-mail Address /
City ��� l State Zip Q Telephone ?.. L f 637.
ENGINEER'S NAME Firt
Last sLic. No.
Engineer's Address Engineers E-mail Address
(' (all- ���
City � �' State � Zip Telephone[�
CONTRACTORS NAME/COMPANY Lic: No. Class
Contractor's Address Contractor's E-mail Address
City [� State �� .ZiP �� Telephone��
SETBACKS REAR SETBACKS FRONT PERMIT NO. M61
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES$