HomeMy WebLinkAboutX2018-2275 - Permit ApplicationPrnt Form Worksheet for Combo Building & Solar Permit Application o�'��'�„'^
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City of Newport Beach - Building Division t
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_Grading rlDrainage riElec FIMech rlPlum CuvdCut F_ CuvdFill F_
Project Address (Not mailing address) FI Flood Fire ri Liq [, Landslide FIN/A Floor Suite No
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Description of Work L t/S
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# Stories # Units (if Res)F
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Valuation $ 7 �n7ed
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New/Add SFIRemodel SFGara a/New/AddMaterial/Labor
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OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
City State F —i,. Zip Telephoned
APPLICANT'S NAME Last T� it �(-� First t �p
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Applicant's Address Applicant's E-mail Address
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City lam"-t-�J56, r Sl tk�� State I `A Zip qU� 2 i Telephone 5'fq Oct -s:� f
ARCHITECT/DESIGNER'S NAME Last �i/�//%L/ First /jT(DLic.N YLZyS�
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Architect/Designer's Address Architect/Designer's E-mail Address
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City - State � Zip I TelephoneF
ENGINEER'S NAME Last First Lic. No. I
Engineer's Address Engineer's E-mail Address
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City', State �—; Zip F_ Telephoned_
CONTRACTOR'S NAME/COMPANY Lic. No. I7 / jj Class
Contractor's Address Contractor's E-mail Address
City . State F Zip F TelephoneF
SETBACKS REAR SETBACKS FRONT PERMIT NO. X20I•� • LZ'j b'
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $