HomeMy WebLinkAboutX2017-0082 - Permit Application (2)Klun- D92-
Worksheet for Combo Building & Solar Permit Application
F Comm] -Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding F_ Grading r-Drainage F Elec F_ Mech F- Plum Cu Yd Cut Cu Yd Fill F
Project Address (Not mailing address) f— Flood F_ Fire [_ Liq F_ Landslide F_N/A Floor Suite No
F3&13 f
4� 0,4
Ch
Description of Work
--_
Use F—Const Type F
0" x 3 h htQsk_ wg
ower Atl�y-
# StoriesF- # Units (if Res)!
. I
I
40P
-
it�000
New/Add SFF¢�®i� Remodel SF
Garage/New/Add ��
Valuation $
Material/Labor
OWNER'S NAME Last F r
1
First JA/11
Owner's Address
Owner's E-mail Address
v 3 Ste► a�� 'Dr.
City , r State ! C- -
Zip F1 U;63 Telephonei !p 71 6 •7 e0,6,
APPLICANT'S NAME Last ��
First
Applicant's Address
Y+2-_
Applicant's E-mail Address
�vi cleyo j ��
City State®®
�L�j Telephonel
��Zi�p
s
ARCHITECT/DESIGNER'S NAME Last `�G��jV First G iG Lic. No.
Architect/Designer's Address
Arch itect/Designer's E-mail Address
City State /��
Zip ' 6 ) Telephoned 615 2�2
ENGINEER'S NAME Last V
First= Lic. No.
Engineer's Address
Engineer's E-mail Address
City State
Zip Telephonel�
CONTRACTOR'S NAME/COMPANY +
Lic. No. Class
Contractor's Address
Contractor's E-mail Address
City State
Zip Telephone,
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $