HomeMy WebLinkAboutX2017-2365 - Permit ApplicationWorksheet for Combo Building & Solar Application
(- COmm9f�Residential City of Newport Beach - Building Division
NOTE' PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
Q D, �¢t� I iC Use F Const Type F '
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# stories # Units (if Res)
-' Valuation $ i
New/Add SF $emodel SF GaragelNew/Add Matedal/Labor E
OWNER'S'NAME an:
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First
° . Owner's Address
- Owner's E-mail Address
CityState Zip 1 Telephone y GAJ yL.
APPLICANTS NAME : LastFirst
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Applicant's: Address
Applicants E-mail,Address
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ZAP 9 Telephone
ARCHITECT/DESIGNER'S NAME
Last/j GL( `First �— Lic No. 3
ArcfiitectlDesigners Address
Architect(De igneYs E-mail Address
City
State `. P Far 71730 Telephone d K2ZZ
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ENGINEER'S NAME Last
First Lic. No. • 6-�/
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;., Engineer's Address
Engineer's E-mail Address
State F Zip F Telephone —
Lic. No. Class
Class
ontractor s E-mail Address
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State ( Zip / AejD Telephone 9
SETBACKS FRONT PERMIT NO.
� SETBACKS RIGHT
PLAN CHECK NO.
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