HomeMy WebLinkAboutX2019-0609 - Permit Application (3)X2o� CA -OCO C) Cl
City of Newport Beach- Building Division pp Rr
orksheet for Combo Building & Solar Permit Application
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Residential rE��
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F,q_Building F_ Grading [—Drainage F_ Elec F_ Mech F- Plum CuvdCutF CuYdFill
Project Address (Not mailing address) F Flood Fire Liq Landslide F_N/A Floor Suite No
Description of Work
Use [_ Const Type
1\2 E V0 Cm (,/ \1" wit C �" c":.�,
# Stories #Units (if Res)
/�
1.'\
Valuation $
Material/Labor��
New/Add SF Remodel SF
Garage/New/Add
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
City I Ct-/141 `- E K, , KA;C State Zip Cr f Telephone
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
cU q l/ L Q^5m— lZ�`
City 6 State
Zip � Telephoned
ARCHITECT/DESIGNER'S NAME Last �
First F_ Lic. No.
Arch itect/Designer's Address
Architect/Designer's E-mail Address
City State F__
Zip � Telephonef .
ENGINEER'S NAME Last
First Lic. No.�
Engineer's Address
Engineer's E-mail Address
City F State
Zip � Telephones
CONTRACTOR'S NAME/COMPANY
Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City State
Zip [_ Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $