HomeMy WebLinkAboutX2019-4025 - Permit ApplicationL�ll
Print Form Worksheet for Combo Building &Solar PermAppllcatlon i EwP
Comm" Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding Grading rDrainage [_Elec FMech
I— Plum cuYdCut cuYdFill
Project Address (Not mailing address) F_ Flood
F— Fire F— Liq r Landslide F_N/A Floor Suite No
Description of Work
Use F ConstType
# Storied # Units (i 'Re
Valuation $
Material/Labor
New/Add SFr Remodel SFr Garage/New/Add
OWNER'S NAME Last ��ll�/
First
Owner's Address
Owner's E-mail Address
?% i%I r 7 /1
City /U"����� State
Zip Telephone
APPLICANT'S NAME Last
First
Applicant's Address J�15XLi1'/
Applicant's E-mail Address
City State �—
-
zipl Telephoner,i;j
L
/�—
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
(-----'--------------------
Architect/Designer's E-mail Address
City � State F
Zip F_ Telephoners
ENGINEER'S NAME Last j�/�Gh%/
First Lic No. Cj
Engineers Addd/ress/�fn
Engineer's E-mail Address
City O� State per,
�i
Zip Telephoned
CONTRACTOR'S NAME/COMPANY
Lic No. F Class
Contractor's Address
Contractor's E-mail Address
City State �
Zip TelephoneF—
SETBACKS REAR SETBACKS FRONT
PERMIT NO. E�oJ Cv( —
SETBACKS LEFT SETBACKS RIGHT
,PLAN CHECK NO. �G' -- 7 e'
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $