HomeMy WebLinkAboutX2017-3056 - Permit ApplicationXti01-7 - V�G
Wo,rkshee,t for Combo Building & Solar Permit Application °
F_ Comm'[ `'r ResidentialCity of Newport Beach - Building Division a
O NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c<wa
Building F_Grading
F–Drainage F_Elec F–Mech PlumuvdcutF CuvdFill F v
Project Address (Not mailing address) [- Flood F' e?� Li Landslide [N/A Floor suite No
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Description of Work UI -1-)C) PAM pg�
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# Stories #Units (if Res)
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OWNER'S NAME
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Owner's Address
Owner's E-mail Address
City
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APPLICANT'S NAME
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Applicant's Address2
Appplicarifs EE -mail Address
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City ,f /Z,
State
Zip Telephone
ARCHITECT/DESIGNER'S NAME Last
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First-_ _ O � ��
Architect/Designer's Address
Architect/Designer's E-mail Address
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City _
State
Zip I Telephone
ENGINEER'S NAME
Last First F Lic. No f
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Engineer's Address
Engineer's E-mail Address
City -
_ _. - State F
Zip F_ Telephoned
CONTRACTOR'S NAMEICOMPANY
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Lic No.F3 b?p Class
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Contractor's Address
Contractor's E-mail Address
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SETBACKS REAR
SETBACKS FRONT
PERMIT NO. Vvl� 3
SETBACKS LEF
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $