HomeMy WebLinkAboutX2017-1390 - Permit Application (3)Worksheet for Combo Building & Solar Permit Application a e
Com'I r Residential City of Newport Beach -Building Division V01-7-1346
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ro..
[7Building r7' Grading [";Drainage [j Elec r_7 Mech ` I7 Plum Cuvd cutF Cu Yd Fill F-
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Project Address (Not mailing address) C Flood `❑ Fire f'Liq Landslide _JN/A Floor Suite No
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Description of Work.
Use C Const Type
# Stories[ # Units (ifRes)n
11
New/Add SFC JI Remodel SF�; Garage/New/Add �—�
Valuation :
Material/Laa bor C"/-"i✓)� —
OWNER'S NAME Last p� _ First �-
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Owner's Address O_ wner's E-mail Address
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227 -
City .- State , Zip Telephone
APPLICANT'S NAME Last � _0 First
Applicant's Address -; Applicants E-mail Address
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City p�7
State Zip Telephone 2
ARCHITECT/DESIGNER'S NAME; Last o ` First Lic. NoT77-77"11-
Architect/Designer's Address Architect/Designer's E-mail Address
-- -- - — ------- ----------
city ._ State Zip Telephoned
ENGINEER'S NAME Last I First Lic. Nof7
Engineer's Address ;Engineer's E-mail Address
City _ State F_ Zip 17 _7 Telephone
CONTRACTOR'S NAME/COMPANY t Lic. No. C Classn
Contractor's Address Contractor's E-mail Address
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Cdy 7 State 1 Zip �, Telephone,
SETBACKS REAR SETBACKS FROM ' PERMIT NO,
SETBACKS LEFT SETBACKS RIC' PLANCHECK N�.USE
ZONE DEVELOFMr PLAN CHECKFEES $