HomeMy WebLinkAboutX2017-2766 - Permit ApplicationX20q_73UU
Worksheet for Combo Building & Solar Permit Application
i Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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(Building , Grading [—Drainage j_ Elec j Mech F— Plum Cu Yd Cut F_Cu Yd Fill ��
Project Address (Not mailing address) F_ Flood F_ Fire F_ Liq F_ Landslide F_N/A Floor Suite No
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Description of Work
Use Const Type
�I aI/
# Stories, # Units (if Res)l y
I-
Valuation $
Material/Laborl
New/Add SF i Remodel SF I
Garage/New/Add
OWNER'S NAME Last \ Z
First .30
Address
Owner's E-mail Address
Owner's
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City I State I
Zip 330 1 Telephone} 46Zp Vql Z_
APPLICANT'S NAME Last �j� vl Z
First! � ,^
Applicant's Address
l
Applicant's E-mail Address
City State
Zip Telephone'
ARCHITECT/DESIGNER'S NAME
Last! 4 o) d zVU
First I r Lic. No.
itect/Designer's Address
Arch itect/Designer's E-mail Address
JArch
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rr I
City i d�Q� n��Tv. c State
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Zip ,�6 Telephone ?y
ENGINEER'S NAME Last i
First':. Lic. No.�
Engineer's Address
Engineer's E-mail Address
1
�
City State®
Zip Telephone,
CONTRACTOR'S NAME/COMPANY I
Lic. No. �— Class
Contractor's Address
Contractor's E-mail Address
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City 1 State
I
Zip! Telephones
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $