HomeMy WebLinkAboutX2019-1353 - Permit ApplicationPrr ' trrth Worksheet for Combo Building & Solar Permit Application
j-- Comm'] F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL V( () 13
rBuilding Grading f—Drainage j_Elec F_Mech
FPlum CurdCut CuYdFill
Project Address (Not mailing address) F_ i" Fire F_ Liq I ` Landslide f_N/A Floor Suite No
I -I
Description of Work
Use CanstTypeF_
# StoriesF_ # Units (if
Res) -Valuation
$
Material/Labor
New/Add SF Remodel SF .r,. vd Garage/New/Add �m-�—
OWNER'S NAME Last `�5
First l,<
Owner's Address
Owner's E-mail Address
City N+'�{Jt�Q-t.fit State r�
Zip et2 && Telephone AIL"_ ,89-W, 5 CLw*,
APPLICANT'S NAME Last F_
First
Applicant's Address
Applicant's E-mail Address
City State
Zip F_ Telephone[—
ARCHITECT/DESIGNER'S NAME Last
First F_ Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State
Zip [ Telephoned
ENGINEER'S NAME Last
First F— Lic. No f —
Engineer's Address
Engineer's E-mail Address
City F` State �—
Zip Telephoner —
CONTRACTOR'S NAME/COMPANY
Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City State F__
Zip F— TelephoneF_
SETBACKS REAR SETBACKS FRONT
PERMIT NO. • F�.�S�
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $