HomeMy WebLinkAboutX2017-3161 - Permit Application (2)Worksheet for Combo Building & Solar Permit Application
F_ Comm1 F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[-,Building F_ Grading F -Drainage F_Elec F_Mech F -Plum Cu Yd Cut l Cu Yd Fill
Project Address (Not mailing C Flood F- Fire F_ Liq F_ Landslide [N/A Floor Suite No
�address)
Description of Work
efL Const Type
�O a
# Stories[ # Units (if Res)
Material/Labor j--!
Valuation $
New/Add SF� Remodel SF Garage/New/Add-,
OWNER'S NAME Last LQ�--0�. -- Firsthr-\,_.--
Owner's Address Owner's E-mail Address
C (o Ch e r vtel
City -- („, ,,n_W - Y12c. _ State I ', zip __ -O Telephone
APPLICANT'S NAME Last First
Applicant'sAddress Applicant's E-mail Address
+
City . (n.C>d'. State __l�-R Zi P1' I d Telephone -� �-I 00
/
ARCHITECT/DESIGNER'S NAME Last � q V First Lic. No. D
Architect/Designer's Address Architect/Designer's E-mail Address
- -
City /\, , G j - rse�� State � Zip q� Telephoned
ENGINEER'S NAME Last First Lic. No.
- -- .. - -
Engineer's Address Engineer's E-mail Address
City - State F—' Zip Telephoned
CONTRACTOR'S NAME/COMPANY l� l� Lic No.fC''S5c 0 Class
l
Contractor's Address Contractor's E-mail Address
-° State W Zip T(.__. Telephone
City -1 6
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $