HomeMy WebLinkAboutX2018-0369 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
Comm'Isidential City of Newport Beach - Building Division
Nr1TP PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[—Building 1 Grading F-Drainage Elec Mech
_ Plum Cu Yd Cud Cu Yd Fill1
Project Address (Not mailing address) F_ Flood
i Fire F- Liq F_ Landslide I _N/A Floor Suite No
Description of Work
Use F—Const Type F
# Stories #Units (if Res)
Valuation $
Material/tabor
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OWNER'S NAME Last �,L2Q.�r
_ First F
Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Last
First i
Applicant's Address
Applicants E-mail Address
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Zip �— Telephonel
ARCHITECT/DESIGNER'S NAME Last! W t1( t kvLt Q
First I� Lic. No. N RT
Archite esigner's ddress
Architect(Designer's E-mail Address
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City State(PF
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Zip gZQl(j�2� Telephone;
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ENGINEER'S NAME tLast :
First— Lic. Nw
Engineer's Address
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Engineer's E-mail Address -_
City State
Zip! Telephone,
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CONTRACTOR'S NAME/COMPANY \ i7 Lic. No. _ Class
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Contractor's Address 1,�
Contractor's E-mail Address
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City I State
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Zip Telephone;
SETBACKS REAR SETBACKS FRONT
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PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Q 2Gj P 11�
USE ZONE nFVFI nPIviFNT NO
PLAN CHECK F€ES $ _ S -