HomeMy WebLinkAboutX2019-2484 - Permit ApplicationI
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Worksheet for Combo Building & Solar Permit Application
residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
FV—Cuilding F_ Grading F7Drainage Elec ech Plum, Cu Yd cute Cu Yd Fill
F—
Project Address (Not mailing address) F Flood fF— FRIe Li F_ Landslide Floor Suite No
Description of Work
Use -tonst Typ
# Stori # Units (if Res)71
Vi 3 T dF A) fCA L_ /,erz S
Valuation $
New/Add SF Remodel SF Garage/New/Add l
Material/Labo
OWNER'S NAME Last First r-7-0
Owner's Address Owner's E-mail Address
_e7volvii-i alot
City V__2; State zip! M�e Z Telephoner
APPLICANT'S NAME Last! S First
Applicant's Address Applicant's E-mail Address
City F State Zip F Telephone
ARCHITECT/DESIGNER'S NAME Last Firsta_Wt/ Lic. No.
F F_,�
Architect/Designer's Address Architect/Designer's E-mail Address
City F State R�k Telephone
ENGINEER'S NAME Last Pi First F 014 W 0_�_v Lic. No.r
Engineer's Address Engineer's E-mai[LAddress
(to® � . I&
City A State ZiPFT2 70 Telephone . 7-1
CONTRACTOR'S NAME/COMPANY Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State Zip Telephone
51,
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT -A PLAN CHECK NOT
USE ZONE DEVELOPMENT NO PLAN CHT CFEES $