HomeMy WebLinkAboutX2017-0186 - Permit ApplicationWorksheettor Combo Building & Solar Permit Application�6«
y City of Newport Beach - Building Division 5
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Description of Work
Use Const Type
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Valuation $
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Material/Labor
OWNER'S NAME Last
First
Owner's Address
<Ownees E-mail Address
City State F
Zip Telephone
APPLICANT'S NAME Last
First ll1le
Applicant'ssAddress
Applicant's E-mail Address
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Zip 7 sTelephone
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AR11TECT/DESIGNER'S NAME Last First �UGu� Lic.No.ecUDesigner's
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Archlect/.Designer's E-mail Address
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City 1f/� State
Zip Tele hone
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ENGINEER'S NAME Last�� Ejf�C7 .. First,— Lic. No f'pyl,
`.Engineers Address -
Engineers E-mail Address
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City �� (o (% id State —
Zip j Telephone ; ,0 s to
CONTRACTOR'S NAME/COMPANY
Lic. No. �— CiassF
Contractor's Address
Contractors E-mail Address
City State
Zip F Telephoner
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. - X n /
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.'
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $