HomeMy WebLinkAboutX2019-1265 - Permit ApplicationPript Form Wor for Combo Building & Solar Permit ApplicationOF'S
F_ Comm'I F_ Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(`Building F_ Gradingramage F Elec F Mech F_ Plum CuvdCut F CuvdFill
Project Address (Not mailing address) Flood Fire F- Liq Landslide Floor Suite No
Description of Work
t Use F— ConstType'
# Stories # Units (if Res)F—
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New/Add SF�— Remodel SF� Garage/New/Add Valuation$ ��', Material/Labor 35) �o
OWNER'S NAME Last/ ^
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Owner's Address
Owner's E-mail Address
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City I IuQ.I/�J State.,. Zip Telephone
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APPLICANT'S NAME Last First a ^
Applicant's Address Applicant's E-mailAddress'"
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City Je lV�� State C-{9— Zip Telephone..._—...._--.—
FET/DESIGNER'S NAME Last
1.. FirstL.,zic. No, F_
Architect(Designer's Addres Architect/Desig er's mail Address
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city %. 9.. I /d'Ar i— StAt i 11_ lin ;\/) F;Z
ENGINEER'S NAME First V 1i ��
Last rJ�^jam- Le- a Lic. No.
Engineer's Address Engineer's E-mail Address
City � � ��..`\ State F Zip q2 Telephone qqq 2p z G
CONTRACTOR'S NAME/COMPANY Lic.. Nol SS7Z Classl
Contractor's Address Contra'ctor's E-mail Address
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City lr°_'rejP.ry State Zip Telephone �]Z�'�j� 5 l• / 2�
BACKS REAR SETBACKS FRONT PERMIT NO.
ETB CKS LEFT SETBACKS RIGHT PLAN CHECK NO.
SE NE DEVELOPMENT NO PLAN CHECK FEES $