HomeMy WebLinkAboutX2017-3783 - Permit Application,z64q ,2017
X2017 - 3783
Worksheet for Combo Building &,Solar Permit Application
sidential City of Newport Beach - Building Division
'�D N CHECK FEES DUE AT TIME OF SUBMITTAL
r Grading [-Drain eElec r Meck r, Plum cuvdcut a,vdFill 71 F
ect Address (Not' mailing address) Flood' F Fires Liq F- Landslider_N/A Floor Suite No
Jz-
Description of Work
UseConst Type .'
1�
# Stories7l # Units (if Res)F
�2 p
Valuation $ ,.
Material/Labor
-
New/Add SF (� =/ Remodel SF Gara /New/Add�i:
OWNER'SNAME Last
t�
Owner's Address
Owners E-mail Address Q�
- City State Zip F', Telephone'—
APPLICANT'S NAME' Last rU First a
Applicant's Address Y aM9--'` Applicant's E-mail Address
,City /i7 _ _ ) State Zip Telephone
ARCHITECT/DESIGNER'S NAME Last / 12sd First Lic.No. �
Architect/Designer's Address V Architect/Designees E-mail Address
07 53 r5. 71
: City eW . State Zip lep o e .y .
ENGINEER'S NAME Last �rj First „R y� jVy Lic. No.F
,
.: Engineers Address Y Engineer's'iE-mailAddress
' ty State F Zip Telephone—
CTOR'S NAME/COMPANY I r/ ,pn. /�%i?/`ZC�-� Lic. No: �7�� Class
I xC(� �.
ddress Contractor's E-mail Address -
,"
Z ` e:?
\
/Telephoners?(j�Z
State Zip
SETBACKS FRONT PERMIT NO.
SETBACKS RIGHT PLAN CHECK NO. —°
DEVELOPMENT NO PLAN CHECK FEES $