HomeMy WebLinkAboutX2018-0578 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F -Building (- Grading F -Drainage F_ Elec r Mech
F- Plum Cu Yd Cut F- Cu Yd Fill
Project Address (Not mailing address) [ Flood
F- Fire r Liq F_ Landslide [N/A Floor Suite No
Description of Work
Use Const Type
# StoriesF_ # Units (if Res)
Valuation $
New/Add SF Pf Remodel SF Garage/New/Add F
Material/Labor�
OWNER'S NAME Last) �.��
_ First ��nki ( �
Owner's Address
Owner's E-mail Address
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Zip F� Telephone
APPLICANT'S NAME Last7Q Y (7
First
Applicant's Address
Applicant's E-mail Address
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.City IEU�>Ot--aL1. State Ir Zip "/2%2. Telephon ���...(X ! / -
ARCHITECT/DESIGNER'S NAME Last OM1//� First -� Lic No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State �---v
Zip F --. Telephoned -
ENGINEER'S NAME Last � l�-
First F_ Lic. No.F--
Engineer's Address
Engineer's E-mail Address
City ( State �— Zip TelephonesF_
CONTRACTOR'S NAME/COMPANYfJ✓��aV+yjc)
Lic. No. Class
Contractor's Address
Contractor's E-mail Address
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City {v�UYE �Q(�MJI-_-
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $