HomeMy WebLinkAboutX2017-3557 - Permit ApplicationX Z011- 3S5 I Worksheet for Combo Building & Solar Permit Application
Comm'f [ Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
FjBuilding C Grading
F prainage F-Elec Mech [Plum ' CuvdCut �I CuvdFill
Project Address (Not mailing address) rC Flood [-j Fire [ Liq F_ Landslide ❑N/A Floor Suite No
F_
Des ription of Work
Use FI Const Type n
# Stories # Units (if Res)n
New/Add SF�
Remod
Garage/New/Add I
Valuation $
Material/Labor
r
OWNER'S -NAME
Last ` First
Owner's Altddress
Owwnneer's E-mail Address
p
City
�Y
State L Zip
TelephotC$a
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's-E-mail,Address
City
J State F Zip, Telephone
ARCHITECT/DESIGNER'S NAME Last ' First
Lic. No.
;. Architect/Designer's:Address
'. Architect/Designer's E-mail Address
City
— --- —
State ZIPF__
j Telephone j
ENGINEER'S NAME
Last First Lic. No.r77777
'Engineer'sAddress
Engineers "E-mail Address
City
-- ----
-�
State Zip .�i
Telephone
CONTRACTOR'S NAME/COMPANY j Lic. No Class
Contractor's Address
Contractors E-mail Address
city
State r___.__i� Zip �1 Telephoned
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES