HomeMy WebLinkAboutX2017-0701 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
F Comm'I ( Residential City of Newport Beach - Building Division o a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ° •aa"
Keuilding F_ Grading F -Drainage �Elec j-Mech �Rlum Cu rd cute Cu yd Fill F
/Project Address (Not mailing address) C Flood ire r Liq F_ Landslide [N/A Floor Suite No
Description of Work Use r' Const Type F
toriesF-2- #Units (if Res)
Valuation$DOp
New/Add SFF Remodel SF F— Garage/New/Add F_ Material/Labor 30/
OWNER'S NAME Last A 2 'gam First A Q T.)
Owner's Address ,. ` Owner's E-mail Address
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City I 1 ,�?� State� zip 4Z 5` Telephone
APPLICANT'S NAME Last /S First E
Applicant's Address V Applicant's E-mail Address
7✓ -3 CAS /noNT _ _
City _ �I�J(/JE _ State Zip _ �'2Z O� Telephone �(i 27Ss 3073 2
ARCHITECT/DESIGNER'S NAME Last First Lic. No. �—
Architect/Designees Address Architect/Designer's E-mail Address
City State F— Zip F-- Telephone
ENGINEER'S NAME Last First F Lic. NoF--s
Engineer's Address Engineer's E-mail Address
City State Zip Telephoned-
CONTRACTOR'S NAME/COMPANY �1IR L7Lic. No. W, Class
Contractor's Address J Contractor's E-mail Address
391 EVtRt-Y 3 03YO
City LOS hn�6ALES State �— zip L>0tf$ Telephone �Q> Z7S` +d t{ (a
SETBACKS REAR SETBACKS FRONT 263(5-2�M,,,�57 PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $