HomeMy WebLinkAboutX2017-4024 - Permit Application- Print Form Worksheet for Combo Building & Solar Permit Application o 9ff'°„ra
Comm'I F-1 Residential
City of Newport Beach - Building Division q
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
1suilding rGrading r-Drainage F7,Elec rlMech
rlPlum CuvdCut n CuYdFill F
Project Address (Not mailing address) F7 Flood F, Fire rj Liq rJ Landslide ❑N/A Floor Suite No
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Description of Work
Use . ConstType77
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# Stories # Units (if Res)
Valuation $
Material/Labor,,
New/Add SFF� Remodel SF�'1Garage/New/Add F�i
OWNER'SNAME Last KfVt( NA,- First jam( l,t. j
Owner's Address
Owner's E-mail Address
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City 1 F-\A0 + ', State I -" \ �
Zip cl y n i Telephone -1� _ I.� "•�1��
APPLICANT'S NAME Last I I First V4 F--V— I
Applicant's Address
Applicant's E-mail Address
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City 'TUB-,'jlv _ _--...--- State ICA_" ��
Zip q`y�C� Telephone -7ILf r-2�li.2-•->t�(�-
ARCHITECT/DESIGNER'S NAME Last r ovov
_ First ( .,( Lic. No. _
Architect/Designer's Address
Architect/Designer's E-mail Address
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City '"CV��-'('I State
Zip k 0?-70 Telephone `) 19 2'-t�
ENGINEER'S NAME Lastlk Au
First iI Lic. No.
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Engineer's Address
Engineer's E-mail Address 11L W
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City I CLt� n(� State • I
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Zip 4 Q.F Telephone. �49 - -1 �� -C.l (q5
CONTRACTOR'S NAME/COMPANY
Lic. No. Class'.
Contractor's Address
Contractor's E-mail Address
City State F
Zip — Telephone�ll
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 4�,�7,,y,
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Z
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $