HomeMy WebLinkAboutX2017-2603 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application °^
Comm'I -Residential City of Newport Beach - Building Division a _
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Prot mailing address) F- Flood F_ Fire (- Liq F_ Landslide FN/A Floor Suite No
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Description of Work
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#Storiesr_- #Units (if Res)I'
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Valuation $ oU
Material/Labor� C)c,
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OWNER'S NAME Lastl�,�.J`y�Q ^��,�^Astl
Owners Address mail Address
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APPLICANT'S NAME Last First I
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Applicant's Address Applicant's E-mail Address
City State Zip I TelephoneF
ARCHITECT/DESIGNER'S NAME �-
Last N e-A S� pe�� � Lic. No.
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Architect/Designers Address Architect/Designers E-mail Address
City-- State j Zip F_ Telephone
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ENGINEER'S NAME Last!I�1 Lich .,
Engineers Address Engineers E-mail Address _
City I State 1 C.� Zip'9ap3 D Telephone y A9 -21
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CONTRACTOR'S NAME/COMPANY Lic. No. 19 Da 0y2 Class
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Contractors Address Contractors E-mail Address —
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SETBACKS REAR SETBACKS FRONT PERMIT NO. 201 ?j-
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO
r rc❑ �nnrP nwcr nD6,iPnIT Mr) FLAN CHECK FEES $