HomeMy WebLinkAboutX2017-3033 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
j- Comm', F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT. TIME OF SUBMITTAL
ON
F-Building F_ Grading
F -Drainage F-Elec f-Mech I,_ Plum cuvdcutF cuvdFill
Project Address (Not mailing address) r Flood F- Fire F- Liq F_ Landslide I _N/A Floor Suite No
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Description of Work
Use Const Type Ir —
YP
#Stories #Units (if Res)
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Valuation .$ l 50 m
Material/Laborl /
7`� —
New/A d SFS
Remodel SF �— Garage/New/Add
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w \ 2
2 0
OWNER'S NA Lastl First Z '�
Owner's Address
Owner's E-mail Address
city I
State. Zip F Telephone—
APPLICANT`S NAME
Lasti First i j,Q , C
Applicants Address
Applicants E-mail Address
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City S?R,f,�y\J (ij l✓
State ��, Zip ! F,7 Telephone �Z Z r, ye 4D 0, l S
ARCHITECT/DESIGNER'S NAMEI
Last I . _ First Lic. No.�
Architect/Designer's Address
Architect/Designer's E-mail Address
City i.
State 1 Zip 1—.— Telephoner
ENGINEER'S NAME
Last i First i1 Lic. No.F_-
Engineer's Address
Engineers E-mail Address
,City
State Zip { .Telephone—
CONTRACTOR'S NAME/COMPANY�� %1%} APV �/1�l �� fie✓ c No. g73.� /f(� Cla
Contractor's Address
Contractor's E-mail Address
31 � y� spor e
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City i �� vCOL
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State lc,�- zip, Telephone,
SETBACKS REAR
SETBACKS FRONT PERMIT NO.(�'