HomeMy WebLinkAboutX2018-2711 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application
r Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Vuilding r Grading rDrainage r.Elec r.Mech r Plum Cu.YdCut F_ CuYdFill F_
Project Address (Not mailing address) r Flood r Fire n, Liq r; Landslide rN/A Floor Suite No
Description of Work
Use " onst Type I
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# Stories��#Units (if Res) '
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Valuation /` lye
Material/Laa bor (/ i
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New/Add SF � Remodel SF � Garage/New/Add F
OWNER'SNAME Last ` ,kk�_G First
Owner's Address Owner's E-mail Address
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City State �—�� Zip F—'. Telephoned
APPLICANT'S NAME Last First � fl y
Applicant's Address Applicant's E-mail Address/
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City IJ A`.%3 .c 1Cj L-A.V:D State I ` ; ''. Zip 72662 Telephone -J`J`1 " �d `3`3 ` i-7 % /
ARCHITECT/DESIGNER'S NAME Last 2A/tj First �-/ad�i,��,.7 Lic. No. -'�y�yJ
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Architect/Designer's Address Architect/Designer's E-mail Address
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City State �—Zip F_ Telephoned
ENGINEER'S NAME Last First F Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State F Zip F Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. F Class
Contractor's Address Contractor's E-mail Address
City Slate � Zip F Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO. i( {1 -` -Z,7
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. /j,� S-7 - •'
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $