HomeMy WebLinkAboutX2018-3086 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
Comm1 Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building 1 Grading F-Drainage b?Elec Mech
{xPlum CuvdCut � CuvdFill
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Project Address (Not mailing a`d�dress) F_ Flood
f- Fire F- Liq F_ Landslide N/A Floor Suite No
r 7—
G 1 5_'
-CP .
Description of Work
Use F—ConstType F—
# Storiesl F # Units(if Res)
ram^
1G f (�y4�1
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YWlm !V-/X urCS �j
Yuq, fi,41n,5U
Valuation $
Material/Labor
I �--
New/Add SF Remodel SFF_ Garage/New/Add
OWNER'S NAME Last I V �• II `M6
I
- First ICi�(j(ty�(� _-
Owner's Address
Owner's E-mail Address
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City)
State v� ��'r-t'
/^ 6�
Zip— Telephone', b�brj�
APPLICANT'S NAME Last j
First I
Applicant's Address
Applicant's E-mail Address
City
State �—
Zip ( TelephoneI
ARCHITECT/DESIGNER'S NAME Last
First 7—Lic. No.
Architect/Designer's Address
ArcE-mail Address
City
State F—
�esig
—hitect/D'ners
Zip 1 Telephone
ENGINEER'S NAME
Last; s(�1-rtr� jr
First Lic. Lic. No.
Engineers Address
Engineer's E-mail Address
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city L.
State lI
Zipll9 Telephone!"7� 3)'3'q
CONTRACTOR'SNAME/COMPANYLic. No. ,bl/i5�(7� Class
Contractor's Address
Contractors E-mail Address
I
City-[ -
State C�-
- Zip 11 0) I �G�1 Telephone) �ol
SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
I USE ZONE
- npvm nPMFNT NO
PLAN CHECK FEES