HomeMy WebLinkAboutX2019-4115 - Permit Applicationi
Print Form Wo et for Combo Building A Solar I omit Applicati n WP°
City of Newport Beach - Building Division
Comm] Residential , NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL. caaH r
[—Building rading F-Drainage IKElec _Meth Plum CuvdCut CuYdFill F
Project Address (Not mailing address) F_-, Flood r7 Fi ,;� diq F—, Landslide FN/A Floor Suite No
Description of Work � �
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Use Const Type
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it Stories[ # Units (if Res)r
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Valuation $ f (1 • cT(j�(j
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Material/Labor
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New/Add SF R model SE�`/'�S
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Garage/New/Add
OWNER'S NAME Last its ?— Y—
First Fw"t L(,
Owner's Address
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Owner's E-mail Address
City State Telephone ---- Zip I jr��a/ � p 1
Last • �,�
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First �
Applicant's Address
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Applicant's E-mail Address
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City f QJIAT r State r� �
Zip I Ct g,6&3 Telephonelrt
ARCHITECT/DESIGNER'S NAME Last F
• First F� Lic. No.
Architect/Designer's Address
Arch itect/Designer's E-mail Address
City State
Zip r Telephoner
ENGINEER'S NAME Last
First Lic. No.1
Engineers Address (- ��
Engineer's Address
�E-mail
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City f State_
Zip Telephone
COWRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address
Contractor's E-mail Address
City S
Zip Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
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PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ .(�