HomeMy WebLinkAboutX2017-1944 - Permit ApplicationX, 1i - � O�
Print Form Worksheet for Combo Building & Solar Permit Application o�aEWRe
I— Comm'I residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Buildin j� Grading j-"Drainage �'Elec j— Mech (- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) C Flood [ Fire Liq Landslide [N/A Floor Suite No
-"i
Description of Work / Use F Const Type
# StoriesF # Units (if Res)F—
Valuatio
New/Add SF S� Remodel SF Garage/New/Add �— Material/La
OWNER'S NAME Last First t/
Owner's Address Owner's E-mail Address
_ fo Ti� - -
City L State �— Zip F-7 ------- Telephone
APPLICANT'S NAME Last First IV( GI
Applicant's Address Applicant's E-mail Address
State Zip Telephone
City -- -
ARCHITEC ESIGNER'S NAME""Last First Ive dLic. No. .
l- -----— 5 -- -
rchitect/Designer's Address Arch itect/Designer's E-mail Address
----------------
City �/,� / State �— Zip _ Telephone
ENGINEER'S NAME Last First Lic
Engineer's Address Engineer's E-mail Address
City j State Zip Telephone
CONTRACTOR'S NAME/COMPANY �V Lic. No.
Contractor's Address Contractor's E-mail Address
Ciy�O_ G'G��} State C Zip -0� Telephone
SETBACKS REAR
SETBACKS LEFT
USF: ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $