HomeMy WebLinkAboutX2017-1390 - Permit Application (2)Worksheet for Combo Building & Solar Permit Application?`
Comm'I r esidential City of Newport Beach - Building Division 1001-1 - l 3a 0 a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL `'<Fo•r"
rBuilding FGrading
rDrainage F_Elec rMech F_ Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) C Flood F_ Fire F- Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use I Const Type F
StoriesI # Units (if Res)r—
Ibn4e 2o,4#
Valuation $
Material/Labor
P{F %j
Remo I SF Garage
OWNER'S NAME
Last „t ^ p First9 l°) n
Owner's Address
Owner's E-mail Address
City F-1\10kif de
State EF Zip l ' Telephone ' 6�36
APPLICANT'S NAME
Last �- First
Applicant's Address
Applicant's E-mail Address
City
State F_Zip F Telephone®
ARCHITECT/DESIGNER'S NAME Last-- First �— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I
State r— Zip F Telephoned
ENGINEER'S NAME
Last First F --_i Lic. No.F--®®
Engineer's Address
Engineer's E-mail Address
City _ _ _
_ State F Zip ^o_ Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. �— Class
_
Contractor's Address
Contractor's E-mail Address
City
State F__ Zip F__ Telephone®
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. (a.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $