HomeMy WebLinkAboutS2017-0003 - Permit Application (2)q'�A WfiL
Worksheet for Combo Building & Solar Permit Application Saw
Comm'I I Residential City of Newport Beach - Building Division GUj--- 0003
�/ �� NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) Flood
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Description of Work
Use Const Type
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IF Stories # Units (if Res)F
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Material/Labor�l�
'Valuation
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OWNER'S NAME
Last 11 //
First
Owner's Address
Owners E-mail Address
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State Zip—', Telephone /� / _ ,Z,"U–
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APPLICANT'S NAME
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Applicant's Address
Applicant's E-mail Address
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City ._ 1"�-- /lo _
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ARCHITECT/DESIGNER'S NAME Last -Z FirstFV _ J ( � v Lic. No.
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Architect/Designers Address
Architect/Designers E-mail Address
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City State Zip
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eepone
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ENGINEER'S NAME
Last
i First Lic. NoT
Engineers Address
Engineer's E-mail Address
City
State F_ Zip
f Telephoned
CONTRACTOR'S NAME/COMPANY p ]� Lic. No.�OU Pl% Class
Contractors Address
Contractor's E-mail Address
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City
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Gas
SETBACKS REAR G
SETBACKS FRONT 20
PERMIT NO 5?�i-10l�3/ IT �
SETBACKS LEFT (�
SETBACKS RIGHT ,6
PLAN CHEC N0. 0DIq 0
25
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES