HomeMy WebLinkAboutX2017-2187 - Permit Applicationvol- 2c6l
Worksheet for Combo Building & Solar Permit Application
Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) Flood I Fire (° Liq 1 Landslide ! N/A Floor Suite No
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Description of Work
Use Const Type
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# Stories' # Units (if Res)
Valuation $ �—
Material/Labor 3
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New/Add SF Remodel SF'
Garage/New/Add ,�
OWNER'S NAME Last
First
Owner's Address
— —
Owner's E-mail Address
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City i State j
Zip Telephone4
APPLICANT'S NAME Last
First i
Applicant's Address
Applicant's E-mail Address
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City l� State i
Zip i Telephones
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ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
i
Architect/Designer's E-mail Address
City State
ZipTelephone!
ENGINEER'S NAME Last
First 7Lic. No.i
Engineer's Address
Engineer's E-mail Address
City Lis State
Zip ' Telephone' 90q` •Z,(c, •3 7? C C
�-` Lic. No. Class.
CONTRACTOR'S NAME/COMPANY �� ���953� i
Contractor's Address
Contractor's E-mail Address
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City i _�1 . State
Zip Telephones
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �(, .-- Z,,
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 17g2- C) I
I USE ZONE DEVELOPMENT NO
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