HomeMy WebLinkAboutX2019-3036 - Permit ApplicationEnttt Fomt „'t 30�
Worksheet for Combo Building & Solar Permit Application
Comm'I qQ Residential City of Newport Beach - Building Division �I
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
,Building ❑ Grading
Address (Not
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❑Drainage -<Elec F<Mech Plum cuvdCut cuvdFill
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mailing address) ❑Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
Description of Work
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V_lfG � L \ L(C
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Use 177, Const Type 1771
# Stories[7 # Units (if Res)C
New/Add SFRemodel SF7 �i Valuation 5 qQ
Garage/New/Add Material/Labor ,('�,p��
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OWNER'S NAME Last
Owner's Address
City _ State
Owner's E-mail Address
Zip
APPLICANT'S NAME Last First
Applicant's Address-
Applicant's E-mail Address
J
city — I State Zip TelephoneF �
ARCHITECT/DESIGNER'S NAME Last
'i First�— Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State ------Zip Telephone�''i
ENGINEER'S NAME Last � First F—'�—'
I Lic. No. I
Engineer's Address Engineer's E-mail Address
City ---State ZIP �-I TelephoneF_ —"--
CONTRACTOR'S NAME/COMPANY .t� �+ —/ Lic. No. Class ��
�O tRT_ Q �� "" 7% F /
Contractor's Address Contractor's E-mail Address
City State _ d Zip Telephone J4,4�
S a. - / %
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $