HomeMy WebLinkAboutX2019-3947 - Permit ApplicationPrint Form Work! Fh et for Combo Building & Solar Permit Application
Comm'IT (j Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
'Building ❑ Grading FjDrainage bElec Mech Plum Cu Yd Cut j Cu Yd Fill
Project Address (Not mailing address) ❑ Flood Fire ❑ Liq Land —slide /A Floor Suite No
�44
Description of Work 2 �J O
Use �� Onst Type
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#Stories # Units (if Res) I
Valuation $ i
Material/Labor
New/Add SF[. Remodel SF Garage/New/Add
OWNER'S NAME Last First ((�
Owner's Address Owner's E-mail Address
c I t State
y /� . Zip G�- Telephone 'G —3
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APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City I State %� Zip Telephone �._
ARCHITECT/DESIGNER'S NAME Last First
�sE-mail
Architect/Designer's Address -'x"lly,Architect/Desig Address
City State Zip L�I Telephone
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ENGINEER'S NAME Last Q-/ (2, First ot1�
Engineer's Address Engineer's E-mail Address � .._.
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City p �'_ � r State F Zip Telephonel. `�; z; U,�_ d os
CONTRACTOR'S NAME/COMPANY ®g. Lic. No. �f41)��q Class
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Contractor's Address Contractor's E-mail Address 1
City ��� State Zip Telephone &f�_� I2� 2= T.91
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. ! a
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
% I [.� 6A I
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