HomeMy WebLinkAboutX2018-2187 - Permit ApplicationPrint 1=orm Worksheet for Combo Building & Solar Permit Aatio
F Comm'I Residential City of Newport Beach - Building Division ppliCtion
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL wd
ilding j`i Gr ' u-r
a ing I Drainage r; Elec Mech
Project Address (Not i naiiHk�q address) Flood
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on of Work
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A Floor Suite No
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,H/� "�'L?>r� r Use r Const Type L' I
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Stores # Unit
� s (if Res)
New/Add SF Remodel SF
- --- — Garage/New/Add ` Valuation $
OWNER'S NAME Last
Material/Labor `e-w
_____--
% � - -
Owner's Address First
Owner's E-mail Address
City �Vl State
ZiTelephone --- -�
p �CJ
APPLICANT'S NAME
Last
- �__
Applicant's Address First
- A -
pplicant's E-mail Address
City _- (Zy►.�1 State
Zip f1 r Telephone
ARCHITECT/DESIGNER'S NAME J `� � o
Last �
Architect/Designer's Address I ` First
Lic. No. 17777
3Q� �`�� �� Architect/Designer's E-mail Address
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City (1 0 -----
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State �yt� -- —
Zip [ Telephone
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ENGINEER'S NAME to
Last
_ First
Engineer's Address q
�L (;0P Engineer's E-mail Address Lic. No.
City -C/ State 2- @ � Cow,
® Zip Telephone
CONTRACTOR'S NAME/COMPANY
Contractor's Address
city
� - G State ICA7 Zip
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE
DEVELOPMENT NO
Ut �" Lic. No. ' f Class
Contractor's E-mail Addressi��`�Z
POLO 4(-Usfayvx�,
o$Cl� Telephon� (✓Z`�(� _
PERMIT NO. XiJt+q 1f ftQ�
PLAN CHECK NO. —
PLAN CHECK FEES $ ._—t