HomeMy WebLinkAboutX2018-0578 - Permit Application (2)Worksheet for Combo Building & Solar Permit Application
F- Comm1 F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F -Building F_GradingF-Drainage F_Elec F-Mech
F_PlumcuvdcutF-- Cu Yd Fill
Project Address (Not mailing address) C Flood
F- Fire r Liq F- Landslide F__N/A Floor Suite No
Description of Work
Use F Const Type F
# StoriesF # Units (if Res)
Valuation $
New/Add SF PO, Remodel SF Garage/New/Add
Material/Labor
OWNER'S NAME Last_ C.�� _ -
_ Firstg.0yJ
Owner's Address
Owner's E-mail Address
J a T>(hz s
City J a„ i f, .� _ Q State F
Zip F— Telephone
APPLICArNvT'SS NAME Last! 41a `(c>
First
/
Applicant's Address
Applicant's E-mail Address
�Z �w(l�oct Co�cS
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City IA <�., State Zip �t, 5 TeIephon qqq_ � / / - 5Dg:;2_
/�pV,� _
ARCHITECT//'DESIGNER'S NAME Last First F_ Lic. No. �—
Architect(Designer's Address
Architect/Designer's E-mail Address
City State �—
Zip F Telephone -
ENGINEER'S NAME Last /V//q- First Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City State F_
�--
Zip �— Telephone,F_
7 !
Lic. No. �( j�j�OClassr�
Contractor's Address
Contractor's E-mail Address
)2 &IClh0avis
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City _ _ /_`!'I° (,up al�'E Q c(�utate �-
Zip I _.. TelephoneI q4 `7 `;7S(p 7Z -5 -
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $