HomeMy WebLinkAboutX2017-1139 - Permit Application (2)X10 H H1 q
Worksheet for Combo Building & Solar Permit Application
Comm'[ Residential City of Newport Beach - Building Division a =
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
I -Building 1 Grading F-Drainage )-Elec rMech
F_PlumCu Yd Cutl Cu Yd Fill
Project Address (Not mailing address) F_ Flood
F_ Fire F_ Liq (— Landslide F7N/A Floor Suite No
Description of Work
Use I ConstType F—
# Stories # Units (if Res)
Valuation $ 1
New/Add SFI Remodel SFI Garage/New/Add)
Material/Labor) i
OWNER'S NAME Last 1 7i�I�'
First
Owner's Address
Owner's E-mail Address
City �!,(� f7�� State I C�
Zip ( // Telephoned 77 y
APPLICANT'SNAME Last'
First! / /0
Applicant's Address
Applicant's E-mail Address
'City
I State (
Zip Telephoner
ARCHITECT/DESIGNER'S NAME
�L�ays�t
�—
First Lic. No. I
Architect/Designers Address
Architect/Designer's E-mail Address
City State ��
Zip' Telephone! 9ygr�/
ENGINEER'S NAME Last +
I
First i Lic. No.
Engineer's Address i3sys �f ifP�a� �—
Engineer's E-mail Address
City State
Zip �— Telephoned
CONTRACTOR'S NAME/COMPANY
Lic No. _ Class,
Contractors Address
Contractor's E-mail Address
City _ e State !
I
Zip iF— Telephone'
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. di 5g•tA11
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $