HomeMy WebLinkAboutX2017-1861 - Permit ApplicationX2011 IgL01
Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
r Comm'1 YResidential WrWr" PI AN CHECK FEES DUE AT TIME OF SUBMITTAL
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F -Building F_ Grading
Drainage Elec Mech Plum CuvdcutF cuvdFill F
Project (Not mailing address) F7 Flood (— Fire (— Liq Landslide rN/A Floor Suite No
Address
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Description of Work
Use r Const Type
# Stories #Units (if Res)
yea 12rGirt s
Valuation $
Material/LaborF i �C C'
New/Add SF �—
Remodel SF F — Garage/New/Add Fi
OWNER'S NAME
Last (� �� L First ( S s S T i ✓�
Owner's Address
Owner's E-mail Address
city
State �— Zip F— TelephoneF_
APPLICANTS NAME
Last t`7-1 JD First (✓
Applicant's Address
Applicant's E-mail Address
12b�2 0$0
City (G`jyl/I
State � — Zip Flu Telephone?-
ARCHITECT/DESIGNER'S NAME Last I First �— Lic. No. �—
ArchitecttDesigner•s Address Architect(Designefs E-mail Address
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pity
State �— Zip Telephone[—
i. �- Lic. No.7—
ENGINEER'S NAME
LastFirst
Engineer's Address
Engineer's E-mail Address
City �—
State �— Zip �— Telephoned
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CONTRACTOR'S NAME/COMPANY r t5 j–r 1�� S Lic. No. S5 �Z O� Classy
Contractor's Address
Contractor's E-mail Address
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Cityul ) )ZS ✓
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State G4-, Zip ZL & `� Telephoned q H t�_
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111 -7-02 V5 Al -021
SETBACKS REAR
SETBACKS FRONT ERMIT NO. i Imo_
SETBACKS LEFT
SETBACKS RIGHT 1;�_Tz_q� PLAN CHECK NO.
USEZONE ___--
DEVEIOpINENT1,-- _ __ _ u_. ._.. •'PL°ANCHECKFEE."—.