HomeMy WebLinkAboutX2019-3913 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding IW Grading rDrainage F Elec r Mech
r Plum CuvdCut cuvdFill
Project Address (Not mailing address) r Flood F_ Fire F_ Liq F Landslide -_N/A Floor Suite No
Description of Work
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# Stories #Units (if Res)
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Valuation $
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Material/Labor -i/G
New/Add SFF_ Remodel SFGarage/New/Add �—
OWNER'S NAME LastL-j�y �/e First
Owner's Address - /
Owner's E-mail Address
City / ��'elo� State GI �-
Zip CF 6G� Telephone
APPLICANT'S NAME Last
First L,S
Applicant's Address
Applicant's E-mail Address
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City State
Zip i/73f✓ Telephonel�3���/
ARCHITECT/DESIGNER'S NAME Last
First Lic No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State I—
Zip F_ TelephoneF_
ENGINEER'S NAME Last 9, —(,.First
G' � Lic No. � 1
Engineer's Address
Engineer's E-mail Address
City — State liA
Zip �I2G4, Telephone
CONTRACTOR'S NAME/COMPANY Lic No. ClassF
Contractor's Address
Contractor's E-mail Address
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City �� y' . ` State ,121 .
Zip Telephone (.4 55 j)
SETBACKS REAR SETBACKS FRONT
PERMIT N0. XL 0I q "
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $