HomeMy WebLinkAboutX2019-1908 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit Application QComr 'I Residential City of Newport Beach -Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_ Building r Grading F—Drainage F_ Elec F_ Mech
F Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood F— Fire F— Liq F— Landslide F_N/A Floor Suite No
Description of Work
Use F Const Type F
# StoriesF # Units (if Res)[
Valuation $
New/Add SFRemodel SFF— Garage/New/Add ��
Material/Labor $/
OWNER'SNAME Last
First
Owner's Address
Owner's E-mail Address
City I State r
Zip [_ Telephonef .—_
APPLICANT'S NAME Last f
First
Applicant's Address
Applicant's E-mail Address
City State I—
Zip F_ TelephoneF_
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City �— State F
Zip F Telephone��
ENGINEER'S NAME Last
First F_ Lic No.1�
Engineer's Address
Engineer's E-mail Address
City State F_
Zip I TelephoneF_�
CONTRACTOR'S NAME/COMPANYY � jC /,�� /�� Lic NA/ C
�i
Contractor's Address
Contractor's E-mail Address
l05
1�y . C
/
City /S � � r l VS State F�G
1
0 ---
Zip Telephone s�� 7�S^ r7ss
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. C
USE ZONE DEVELOPMENT NO
PLAN CHECK FEE
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