HomeMy WebLinkAboutX2019-0036 - Permit Application (4)Worksheet for Combo Building & Solar Permit Application Sw
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City oewport Beach Building DivisionComm'I � Residential NOTE: PLAN CHECK FEESDUE AT TIME OF SUBMITTAL
F-Building F Grading
F-Drainage Fm Elec F- Mech F- Plum Cu Yd cut 17 Cu Yd Fill 1
Project Address (Not mailing address) Flood F_ Fire ( Liq [—Landslide F_N/A Floor Suite No
-5� NOD
Description of Work
Use Const Type
#Stories #Units (if Res)
Materia'I/Labor
I
New/Add SFF
Remodel SF Garage/New/Add
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
City �
State �•- Zip Telephone
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address .
City �
State Zip `
ARCHITECT/DESIGNER'S NAME
Last First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City. I
State I Zip �® Telephone
ENGINEER'S NAME
Last F First ]� Lic. No.
(Engineer's Address
Engineer's E-mail Address
City
State l Zip �® Telephone
CONTRACTOR'S NAME/COMPANY y '' Lic. No Class
�.� t� )T73 5 _ I
Contractor's Address
_ _ Contractor's E-mail Address
IS 10 G , CIS RX I Q
City
State 5. Zip 6 Telephone,'? ftY_° 664
SETBACKS REAR
SETBACKS FRONT PERMIT NO. ' A
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. 00 W to -
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $