HomeMy WebLinkAboutX2018-3555 - Permit ApplicationW'
Worksheet for Combo Building & Solar Permit Application of a
r Comm'I Residential City of Newport Beach - Building Division o 1
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading �Inage ff Elec Mech
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Project (Not mailing address) F7 Flood F- Fire j- Liq Landslide 1-N/A Floor Suite No
F
�Address
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Description of Work
Use I Y � Const Type �—
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# Stories # Units (if Res)
-10 IUl S
2
�- � uJ
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Valuation $
New/j Ldpf Remodel SF 1�— Garage/New/Add
Material/Labor
OWNER'S NAME Last
Firstl M,
Owner's Address
Owner's E-mail Address
City A ! — / State
Zip T 4j O Telephone
APPLICANT'S NAME Last
First
Applicant's Address
Applicants E-mail Address
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City I�� FqI&AT State 1(::4
Zip lc Zj Telephone��Z�fj
ARCHITECT/DESIGNER'S NAME Last First � Lic. No. 7—
,
Architect/Designees Address
rchitectlDesigne s�E-mail
AAd-drreess
City ; State �—
Zip Telephone
ENGINEER'S NAME Last 1 _
Y-
First 1 elm Lic. No.
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Engineer's Address
Engineer's E-mail Address
City �+���� State
Zip 112 � Telephone: J�-. ZB�- o 01-0
r 7
CONTRACTOR'S NAME/COMPANY Lic No. �— Class�—
Contractor's Address
Contractor's E-mail Address
City �-- 1 State F_
Zip � Telephone)
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.�'1
USE ZONE DEVELOPMENT NO
I
PLAN CHECK FEES $