HomeMy WebLinkAboutX2017-0811 - Permit Applicationx201"1-0`611
Worksheet for Combo Building & Solar Permit Application
F_ Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
0
r -Building F_ Grading r -Drainage F_Elec F -Mach F_Plum Cu Yd cutllllll; Cu Yd Fill
Project Address (Not mailing address) C Flood r— Fire F7 Liq Landslide F_N/A Floor Suite No
Description o or
Use oust iype
r!l G c.dQli
# Stories #Units (if Res)!
CLZ��� tSC
Valuation
New/Add SFFi' Remodel SFF Garage/New/Add F—,,
Material/Laa bor
OWNER'S NAME Last G� First
Owner's Address Owner's E-mail Address v\
HP�.T Q yt44,
City t - --. State d, Zip Telephone r- 3-�;-S 33
APPLICANT'S NAME Last �e - First
Applicant's Address Applicant's E-mail Address
civ%C%� SS s S �Ge—GGA�Y,� c,.o
City _ ,Y,✓•T/ - State Zip s% Telephone ' cCP �_c �S9
c !
ARCHITECT/DESIGNER'S NAME Last First I Lic. No. r ,/
ArchitecUDesigner's Address Architect(Designer's E-mail Address
77
- _ - -... -- _.
City State F_Zip F Telephone—'.
ENGINEER'S NAME Last'First Y� Lic. No. 7�
Engineer's Address Engine E-mailAddress
Ci State �- Zip �— Telephone��.
NAME/COMPANY Lic. NoT— Class
CONTRACTOR'S
Contractor's Address Contractor's E-mail Address
City State 1 — Zip 7— Telephone—
l
TBACKS REAR SETBACKS FRONT PERMIT NO.
TBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $