HomeMy WebLinkAboutX2017-3639 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application o�ew
F. comm" residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F[Building E_-,' Grading Drainage E-IElec F;Mech' F Plum CuvdcutF 7 CuvdFill
Project Address (Not mailing address) Ci Flood . [ Fire F] Liq [ Landslide ❑N/A Floor Suite No
Description of Work
Use n Const Types
# Stories # Units (if Res)
Valuation$
Material/Labor
�F� F-1
New/Add SF Remodel SF Garage/New/Add
OWNER'S NAME Laef. ��vdM��LCi First J,
:Owner'sAddress Owner's E-mail Address.
cityL I V W Qo L.N' State _C J _ Zip J Telephone 7-5-16 7,
APPLICANTS NAME Last First
Applicant's Address Applicant's: E-mail Address
city State L Zip Telephone
ARCHITECT/DESIGNER'S NAME Last - J First Lic: No.
Architect/Designees Address Architect/Designees E=mail Address
-City StateF7i ZipTelephoned
ENGINEER'S NAME Last First F_ Lic. No. F77777
Engineer's Address Engineers E-mail Address
City , State Zip r Telephone
CONTRACTOR'S NAME/COMPANY Q v 1� , �L(� Lic. No. Q Class
Contractors Address; Contractor's E-mail Address
i
City State �' Zip F Telephone[
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $