HomeMy WebLinkAboutX2018-1313 - Permit ApplicationX2M-6313
Worksheet for Combo Building & Solar Permit Application 40-141-111�;
Comm'I Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE ATTIME OF SUBMITTAL
Building 1 Grading j Drainage I Elec { Mech' a Plum cuvdCut )i— cuvdR11
Project Addd/resst (Not mailing address) F– Flood r Fire F_ Liq 1 Landslide I N/A Floor Suite No
Description of Work
Use I Const Type ,F_
f # Stories;: #Units (if Res)—
Valuation $
New/Add SFl Remodel SF— Garage/New/Add Material/Labor
OWNER'S NAME
Last i��G First
Owners Address Owner's E-mail Address
City
Tel
i / Y �/.ri �4(i State Telephone
�t
Zip I� fione'
APPLICANT'S NAME Last 1 i�U�S�U First
Applicant's Address Applicant's E-mail Address
city State Zip)` TelephoneF%� `X�
ARCHITECT/DESIGNER'S NAME Last �! U
.First, Lic.No.l
Architect/Designer's Address - Architect/Designers E-mail Address
�—
City State Zip Telephone—
ENGINEER'S NAME
Last First i Lic.No.;
Engineer's Address Engineers E-mail Address
GityState Zip 7Telephonef�!
CONTRACTOR'S NAME/COMPANY
Lic. No. i Class:
a
Contractors Address - Contractor's E-mail Address
i
City i State Zip Telephone'
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO- / d
NLAiv i,r,Ei,K FEES