HomeMy WebLinkAboutX2019-3625 - Permit Application (2)ty of
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Print Form NOTE: PILAN Newport Beach S DUE AT TIME OF (SUBMITTAL c �
_ Worksheet for Combo Building & Solar Permit Application o4
HECK
eF Nr
Comm'( r Residential
F-Building F_Grading
f-Drainage F-Elec F_Mech rPlum Cu vd Cut Cu vd Fill
Project Address (Not mailing address) I- Flood r Fire r Liq F_ Landslide r N/A Floor Suite No
Description of Work
Use F_ Const Type F_
# Stories[— # Units (if Res)[ —
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
State � Zip F Telephoned
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City
State �� Zip F—Telephoned
ARCHITECT/DESIGNER'S NAME Last First F_ i --
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City
—
State I Zip F_ TelephoneF
ENGINEER'S NAME
Last First F_ Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City
State �— Zip F Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. 7i Class
Contractor's Address
Contractor's E-mail Address
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City L�r�ic%2/� �r n_ /` State Ltdt Zipq�(3c� / Telephone
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SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.D
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $