HomeMy WebLinkAboutX2017-1164 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
r Comm'1 (- Residential Mr)Tr- Pl AN rHFCK FEES DUE AT TIME OF SUBMITTAL
f -Building F -Grading F -Drainage F_Elec (-Mech
Plum Cu Yd Cut - Cu Yd Fill
Project Address (Not mailing address) 17 Flood
F_ Fire r Liq F_ Landslide 1 -N/A Floor Suite No
Description of Work
Use F Const Type
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C I #Stories # Units (if Res}
�1� Valuation$ ^qr
New/Add SF{ Remodel SF� Garage/New/Add' Material/Labor I V r rd V
OWNER'S NAME Last.,
_ - First 1
Owner's AddressOwners
E-mail Address
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City State
ZiP TelephoneG�GiC
APPLICANTS NAME Last /' �! �' y , First J� / - f„--)
Applicant's Address
Applicants E-mail Address
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16:73305
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City ;l �/ State
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zip G/ TelephonJe ��y-�J�D'
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ARCHITECT/DESIGNER'S NAME Last 1
First �— Lic. No. �—
Architect/Designers Address
Architect/Designers E-mail Address
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City State
Zip �— Telephone
ENGINEER'S NAME Last
First Lic. No.F—
Engineers Address
(City'
Engineers E-mail Address
State
Zip F_ Telephone
CONTRACTOR'S NAME/COMPANY )� ��'
Z'Lic. No. %�j j ���Class 6
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Contractors Address
Contractor's E-mail Address
City State F—
Zip �— Telephone
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l o l Y'1
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SETBACKS REAR SETBACKS FRONT Jp V\A�PJRMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE'ZONE OEVELQPMENT 90
PLAN CHECK FEES $_ ,` _