HomeMy WebLinkAboutX2017-2530 - Permit Application (3)Worksheet for Combo Building & Solar Permit Application
Comm'I ;= Residential City of Newport Beach - Building Division
NOTP- PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building 7 Grading f—Drainage 11 Elec F
Mech Plum Cu vd Cut Cu Yd Fill
Project Address (Not mailing address) F_
Flood i Fire F_ Liq F Landslide rN/A
Floor Suite No
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Description of Work
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OWNER'S NAME Last
First
Owner's Address
Owners E-mail Address
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City I State
Zip Telephone; '
APPLICANT'S NAME Last!
First 1
Applicant's Address
Applicant's E-mail Address
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City I State
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Zip Telephone,
ARCHITECT/DESIGNER'S NAME Last
First,
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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City State
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Zip! Telephones
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ENGINEER'S NAME Last!
a First 1
Lic. No.1
Engineer's Address
Engineer's E-mail Address
1.
City State 1
Zip Telephone}
CONTRACTOR'S NAME/COMPANY '
Lic. No. j
Class;
Contractor's Address
Contractor's E-mail Address
City i State !
Zip Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
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PLAN CHECK FEES
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