HomeMy WebLinkAboutX2017-1068 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
Comm'I Residential City of Newport Beach - Building Division _
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading F-Drainage Elec Mech
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Project Address (Not mailing address) Flood
i >l�I Fire F_ Liq andslid (I b � Suite No
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Description of Work
Use 1 ConstType',
Stories, 7i #Units (if Res)'.,
Valuation
Material/Labor;
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JJ
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N •W GJ n��' �� j �R�dY� a ww p MIN
New/Add SFi Remodel SF Garage/New/Add 1,
OWNER'S NAME Last �i. First j el 40J
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Owners Address
Owner's E-mail Address
City 1 14j� f l� 6 State
Zip Telephone; /3�u-ZII ` 9� ;_
APPLICANT'S NAME Lasts W (UI A7 First! Itj9k
Applicant's Address
Applicant's E-mailAddress
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City i �A U "^I IQ State j (wry _
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Zip j qI Z&7'•'� Telephone] �4N.
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ARCHITECT/DESIGNER'S NAME Last'.
First Lic. No.
Architect/Designers Address
i
ArchitecUDesigner's E-mail Address
l
City State I
ZipTelephone'
ENGINEER'S NAME Last
First j Lic. No.',
Engineers Address
Engineer's E-mail Address
City State
Zip Telephone`
CONTRACTOR'S NAME/COMPANY
/ �j 4 ,0�j&C. NoO31OVQ4 Class
Contractor's Address
Contractors E-mail Address
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City State
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Zip Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK
USE ZONE DEVELOPMENT NO
vLAIv t;mECK FEES
1 vilil)