HomeMy WebLinkAboutX2017-1191 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
j Comm'1 j Residential City of Newport Beach - Building Division
NOTE- PI AN CHECK FEES DUE AT TIME OF SUBMITTAL
(—Building j Grading F-Drainage Elec FMech
r`Plum` f CuvdCut � cuydFill
ec����d F 1�1n tL wy
_N/A
Project Address (Not mailing address) Flood
Fire Liq andslide Floor Suite No
Description of Work o
/
Use [_ Const Type F_
rn
# Stories / # Units (if Res)7
((✓✓
�
e` `;r- V F fir/ / k7
a
1 D��
Valuation$
Material/Labor
New/AddSFj Remod ISF�— Garage/New/Add—
OWNER'S NAME Last
Firstl '7j 41 .4>Z
Owners Address
Owners E-mail Address
—9 i f3 S2 i (z Y G i h7T7t
^%
City o_ocv -) �L- A..� State I 014 -
Zip G%.2(.2�- Telephone 'S)D - 7S 1-j
APPLICANT'S NAME LastFL Ac- 7�-,!v tL� First
/
Applicant's Address
Applicant's E-mail Address
City State CAA-
Zip I q Z (� 2 5-Telephone `3�
o2vwA
ARCHITECT/DESIGNER'S NAME Last I
First F— Lic No. �—
Architect/Designees Address
Architect/Designers E-mail Address
City, State
Zip F— Telephoned
ENGINEER'S NAME Last
First Lic. No.
Engineers Address
Engineers E-mail Address -
City State �—
Zip F Telephonel
CONTRACTOR'S NAME/COMPANY
Lic No. I Class;
Contractors Address
Contractors E-mail Address
City ; State
Zip Telephoned
_
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 1 Q'
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
- - PLAN CHECK FEES $