HomeMy WebLinkAboutX2017-3883 - Permit ApplicationX 2,011- 363 y ov] - 15 <7
Worksheet for Combo Building & Solar Permit Applicati
)— Comm1 r Residential City of Newport Beach - Building Division
NOTE- PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
ri�uilding r Grading rDrainage rElec rMech
r Plum Cu YdCutF Cu Yd Fill F
Project Address (Not mailing address) f Flood F_ Firer Liq Landslide F_N/A Floor Suite No
A/
Description of Work
Use F—Const Type F
# StoriesF # Units (if Res)I—
Valuation $
16
r��y%- ITr
L
New/AddSFF Remodel SFF Garage/New/Add F —
Material/abor /,S (✓ 3
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
t
r' 11 a Cril-e(/y,,%aKl
City _ A],,e I / State F/`/T
F
zip F Telephone—.
APPLICANT'S NAME Last fp
First
Applicant's Address
Applicant's E-mail Address (7
Citfy State f—
Zip F Telephonel—
ARCHITECT/DESIGNER'S NAME Last
First Lic. No. �—
ArchitectIDesigners Address
Architect/Designers E-mail Address
City State �—
Zip F—. Telephoned
ENGINEER'S NAME Last
First �— Lic. NoF
Engineer's Address
Engineer's E-mail Address
City i�—— State r
Zip I Telephoned
CONTRACTOR'S NAME/COMPANY �� c,) 0,t
L9 t.1- Lic. No. F�yw6 fClassContractors
Address
Contractor's E-mail Address
City State F �..
yao .t-�-•3
Zip �— Telephone d�— �"3
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $