HomeMy WebLinkAboutX2019-3518 - Permit ApplicationL Print Form I Worksheet for Combo Buflding & Solar Pcrnift Application o��EWPOW
City of Newport Beach - Building Division IX
Comm'I � Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL %C )6 " 3 5 tU
j -Building I- Grading F-Drainage F_ Elec I— Mech [` Plum CuYdCut CuYdFill
Project Address (Not mailing address) IJ Flood F_. jJ Liq F_ Landslide (—N/A Floor Suite No
.11 1_.% F_
Description of Work
Use Const Type F
# Stories[ # Units (i Res)
a'uation $
Material/Labor
New/Add SF�` & Remodel S Garage/New/Add �+
OWNER'S NAME L First
Owner's Address Owner's E-mail Address
City State Zip Telephone qqq -.50p - 3t2, .o
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State Zip �� Telephoned__
ARCHITECT/DESIGNER'S NAME Last - First I-� _ Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip Telephone
ENGINEER'S NAME Last First r Lic. No.
Engineer's Address Engineer's E-mail Address
I .
City L State F Zip Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. — ClassF
Contractor's Address Contractor's E-mail Address
City State F Zip Telephoner --
SETBACKS REAR SETBACKS FRONT PERMIT NO. a F
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $