HomeMy WebLinkAboutX2017-3823 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application��
r;Comm'IResidential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r–Gradingr–Drainage (-Elec FMech [–Plum cu Yd cut (pp i CuvdFill Fo
ProjectiAddress (Not mailing address) Flood [– Fire ( Liq Landslide 1 -N/A Floor Suite No
Description of Work Use Const Type
r �tl�( t (� # StoriesF, Units (if Res)[
-c Valuation $ �I
New/Add'SFF–� — RemodelSF Garage/New/Add Material/Labor
OWNER'S NAME Last First�t'�
Owner's Address ' Owner's E-mail Address
city xol�boj
state Zi P RT 6 t,5Telephone
APPLICANT'S NAME Last
V �J Firstr
Applicant's:Address Applicant's E-mail Address
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city ! l Af C ^ State �� Zip Telephone
ARCHITECT/DESIGNER'S NAME ' Last First— Lic. No. �
Architect/DesionersAddress Architect/Designers'E-mail Address
City 'State �— Zip �— Telephoner
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ENGINEER'SNAME Last ®P��GI� First F— Lic. No.F36
Engineer's Address �Engineers E-mail Address
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ity IU 6 ly., .State Zip l tI S0 Telephone q `l 0�... 63 z Z .
TRACTOR'S NAME/COMPANY C Lic. No. Kgz Class
tors Address Contractor's E-mail Address
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State Zip r1 Telephone
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SETBACKS FRONT PERMIT NO.
SETBACKS RIGHT PLAN CHECK NO
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DEVELOPMENT NO PLAN CHECK FEES $