HomeMy WebLinkAboutX2018-1633 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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r-(Building f—!Grading F-Drainage FElec ❑Mech 10Xlum CuYdCut l CuYdFill
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq Landslide ❑N/A Floor JJJ Suite No
Description of Work Use ®,ConstType
# Stories® # Units (if Res)
Valuation $
New/Add SFF —i Remodel SF C'T S i—, ( Garage/New/Add F__7 Material/Labor *ia:r (7 6
OWNER'S NAME Last First �`"7
Owner's Address Owner's E-mail Address
C�L),jDau GS5
Zip �7 Telephone
City N �v0 p lLT fj� State �_ q . g
APPLICANT'S NAME Last�__,l
�"-1� r�/� S First
Applicant's Address Applicant's E-mail Address
city hm1or-> IQt7 state Cps— zip Telephone clq��Wz) 6
ARCHITECT/DESIGNER'S NAME Last First?
---- Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City I State 177 Zip F J Telephone[
ENGINEER'S NAME Last First F Lic. No. F__
Engineer's Address Engineer's E-mail Address
City J State. �� ZIP[ Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. F Class
Contractor's Address Contractor's E-mail Address
City State Zip Telephoned
SETBACKS REAR SETBACKS FRONT PERMIT NO. X%ol
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. lZ5q 4-01p
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $