HomeMy WebLinkAboutX2017-1844 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
F- Comm'] jKResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(-Building r Grading F-Drainage ' Iec �Mech F- Plum CuvdCut F CuvdFill r
Project Address (Not mailing address)" _ Flood F_ Fire F- Liq-7�_F- Landslide [_N/A Floor Suite No
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Description of Work \ O
Use ConstType
# StoriesFZ # Units (if Res)F—
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New/Add SF Remodel SF x Garage/New/Add �-
Valuation $
Material/Labor SiJ v�
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OWNER'S NAME Last (��74 iA-i First r%O%ilc•�VNN9'
Owner's Address Owner's E-mail Address �_ ✓
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City 6�,oi.,.ie. JEC ���•L State �'/r Z,i/p Gl�rTelephone4i`�T(JZ � ,S _Kj
APPLICANT'S NAME Last �(� 14l'o AJ First �b 4 Ajly )-
Applicant's Address Applicant's E-mail Address
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City �f0 _ State �- Zip 2-6_� Telephone '?<Kg
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ARCHITECT/DESIGNER'S NAME Last 4 /Z 2 z-'v First vWcLic. No. F_
Architect/Designei's Address'' Architect(Designer's E-mail Address
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City �, G N qC_ State C 1 ZiP q Z Y 69 3 Telephone '7�f/- 7 j ' a-U J' t�
ENGINEER'S NAME Last n ram- Fi(rs�Jl -"-� LLii-cl.No.
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Engineer's Address 0r Q O Engineer's E-mail A ress i
City State F_ Zip F Telephoned
CONTRACTOR'S E PA /5p C/C,f,rt�;vc Lic.No. 1_ Class i
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ContractoYs Addre ontrabto s �m ail Address
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City l State Zip Telephone)
SETBACKS REAR SETBACKS FRONT PERMIT NO. x4W k 7 - D �J
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 0 4 1 & - W1
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ 5 /1 . (J q