HomeMy WebLinkAboutX2019-3914 - Permit ApplicationPrint Form I Worksheet for Combo Building & Solar Permit Application
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City of Newport Beach - Building Division a g Com m'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c,'o,,,•�
[--Building [ Grading [`Drainage i`Elec rMech
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Project Address (Not mailing address) r- Flood r- Fire j- Liq r- Lan sl'de f-N/A Floor Suite No
Description of Work
Use ConstType
# Stories[— # Units (if Res)[ —
Valuation $
Material/Labor
New/Add SFRemodel SF�— Garage/New/Add ��
OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
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City � State GJ�W
Zip �-auo TelephoneF ----
APPLICANT'S NAME Last .USA
First erl.,5
Applicant's Address
Applicants E-mail Address
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City 14: _L State "�
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Zip /l`7:3:J Telephone C. !) ".�"-.�Ji5
ARCHITECT/DESIGNER'S NAME Last F
First � Lic. No. �—
Architect/Designer's Address
Architect/Designer's E-mail Address
City State �—
Zip �� Telephoned`
ENGINEER'S NAME Last p
First L6 Lic
Engineer's Address
Engineer's E-mail Address
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W. L,,,'cd4
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City State G'�LL
Zip 92(_,&-7 Telephone (7iY j 4.7 _ /ic/s
CONTRACTOR'S NAMElCOMPANY J Lic No. q f( Y& Class
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Contractor's Address
Contractor's E-mail Address
City �/.' State i
C,-vl�MfJ,9•�.
Zip Telephone Cosy)
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $