HomeMy WebLinkAboutX2017-2492 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application«°°^a
City of Newport Beach - Building Division
f- Comm'I j Residential NnTF- Pl AN CHFCK FEES DUE AT TIME OF SUBMITTAL
[-Building j Grading F -Drainage Vl-Elec I-Mech F- Plum Cu rd Cut Cu Yd Fill
Project Address (Not mailing address) Flood F_ Fire Fi Liq (- Landslide F-N/A� Suite No
,Floor �
Description of Work
Use i
Const Type F_
ri "
1 (�
^�
�t # Stories # Units (if Res)F—
Valuation,
New/ dd Fj ^ Remodel SF�—
Garage/New/Addy Material/Laboi
OWNER'S NAM11--"' Last I
_ First
Owner's Address
Owner's E-mail Address
City _ _ State I
I
-, Zip { Telephonei
LICANT'S NAM Last i (
First ( "J( e
ter.
A ressj]1
Applicant's E-mail Address
}
�s ' ��CiJ7` C C•'''°`�/9 r l__5'l�� 6
i
f�Ia`'"ddg'�.Aw,�f>�,} d� 6C.�`�Q.
�
Ci jN,� ^(��`.(/1J /O) ✓ r; -' ,State ( j.---
Zip Cu ''/q [{� Telephone Abp
r
`" , ` J� �.�
ARCHITECT/DESIGNER'S NAME L st� q��`�/ First
1_
Lic. No.
J
ArchitectlDesigner's Address
Architect/DesigneCCCrJJJs„
Cit}, 11 State
Zip, Telephone)
ENGINEER'S NAME Last
L1 1
First��-
Lic. No.
Engineers Addres
Engineers E-mail Address
c
City WL State A
Zip%AYI Telephone(�/I— ,
CONTRA OR'S NAME/COMPANY
5 Lic. No. {
d Z C Class
.J
Contractor's Address
Contractor's E-mail Address
�PIC,T °/ZAT,� '5T
;�m��icc
City I State 1- Zip, C/ %/ (� Telephon
F
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK N 6.
USE ZONE DEVELOPMENT NO
- ..... .. PLAN "CHECK FEES $"...