HomeMy WebLinkAboutX2017-3084 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
Comm'I Residential )(%a i ' 3
City of Newport Beach - Building Division ! C)H
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding [ Grading F -Drainage r Elec F_ Mech r Plum cuvdcut Cu Yd Fill F7
Project Address (Not mailing address) C Flood F_ Fire [-_ Liq (- Landslide F_N/A Floor Suite No
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F777
Description of Work
Use �, Const Type
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# Storiesr_,l #Units (if Res)F—�
Valuation $
New/Add SFF Remodel SF 7—Garage/New/Add
Material/Labor -7.
OWNER'S NAME Last �/(/f� First l s
Owner's Address Owner's E-mail Address
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City _ t a\ NriE.- i State --Zip F— Telephone—',
APPLICANT'S NAME Last �ST- First
Applicant's Address Applicant's E-mail Address
City State Zip �— Telephoned -
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect(Designer's E-mail Address
City State F Zip F Telephone)
o5EngENGINEER'S NAME Last I CH KJ S(6 _ First W -LE. Lic No.. Z._765-
ineer's Address Engineer's E-mail Address
Engineers
c744 W,_K c -* A-V -- f- -1()T-
City __.0.IZxtN QE ____ _ State I EA . Zip F128%7 Telephone 7/4' F7 -of—
CONTRACTOR'S NAME/COMPANY K ( AJ Gk rJ=- C� J Lic. No. R16air 2Class F
NContractor's
Contractor's Address E-mail Address
City State f Zip F TelephoneF
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. -Z-6r-)
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $