HomeMy WebLinkAboutX2017-2393 - Permit Application (3)17094017
•- X 201-7•,2343
Worksheet for Combo Building & Solar Permit Application
F- Comm'I Residential City of Newport Beach - Building Division s
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding (-Grading
F -Drainage F_Elec F`Mech F -Plum CuvdCut CuvdFill
Project Address ((Not mailing address) F_ Flood _ F Fire F- Liq F- Landslide F7,N/A Floor Suite No
Description of Work
Use F Const Type
# Stories # Units (if Res)[
Valuation $
New/Add SFF_!
Remodel SFF Garage/New/Add
Material/Labor ) l(s
OWNER'S NAME
Last First
y
Owner's Address
Owner's E-mail Address -
City
State .Zip Telephoned
APPLICANT'S NAME
Last First
Applicants Address
Applicant's E-mail Address
:City _ _
State Zip Telephone0
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F `-
Architect/Designer'sAddress
Architect[Designer's:E-mail Address
City
State Zip Telephoner
ENGINEER'S NAME
Last First Lic. No.1
Engineer's M -dress
Engineer's E-mail Address
City r
State Zip Telephoner
CONTRACTOR'S NAME/COMPANY ' ® Lic. No. r`1 �Class�
Contractor's Address
Contractor's E-mail Address
City i/
State Zip r Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. tJJ&% 1
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $