HomeMy WebLinkAboutX2017-2422 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
F_ Comm'I (- Residential xZol�'
City of Newport Beach - Building Division ZLtz Z
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-NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �.o*
ftuilding r -Grading rDrainage F_Elec rMech F -Plum CurdcutF CevdFill
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Project Address (Not mailing address) F_ Flood F- Fire r Liq F_ Landslide ' F -,N/A Floor Suite No
Description of Work
Use F Const Type.
# Stories #Units (if Res)
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f ASIA It t_
Valuation
New/AddSFF— Remodel SF�— Garage/New/AddF—
Material/Laabor SQ6
FAj
OWNER'S NAME Last &oAAASdf3 First ( V
Owner's Address Owner's E-mail Address
°i C)ej 0. 8e1 yT i v..�F P4C. - %
City IS State 1� Zip G41e2 Telephone—
APPLICANT'S NAME Last 'L CW 1-3 First a r,t 1
Applicant's Address Applicant's E-mail Address
r u,
City %t!_ State I ��t Zip Al2((6 Telephone ej
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designet's Address Architect/Designer's E-mail Address
City F State Zip I Telephone—
ENGINEER'S NAME Last First Lic. No.1,—
Engineer's.Address Engineer's E-mail Address
`City State 7— Zip �— Telephoner
-� Lic. No. S 1 73p ClassFx-
CONTRACTOR'S NAME/COMPANY rr
Contractor's Address Contractor's E-mail Address
City — State I Zip e)�4V Telephone q�� 6r6 1(4/(,5
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SETBACKS REAR S7/ - SETBACKS FRONT , d PERMIT NO.
SETBACKS LEFT 3 SETBACKS RIGHT V PLAN CHECK NO.
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