HomeMy WebLinkAboutX2017-2305 - Permit ApplicationI
Rtlot Form,, Worksheet for Combo Building &Solar Per pp
lication
City of Newport Beach -Building Division
❑ Comm -1 ❑ Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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❑ Grading
Address
of Work
New/AddSF
❑Drainage ❑Elec [7Mech FPlum cava
Liq F) Landslide
address) E71 Flood ❑ Fire ❑
Remodel SFF____7 Garage/New/Add �I
OWNER'S NAME Last
Owner's Address
9-/-4- --lei' �----
State ��
/Q
City /V/�yrvrly le2C-G--C�--
APPLICANT'S NAME Last
Address
city
ARCHITECT/DESIGNER'S NAME
First
Cu Yd Fill
❑N/A Floor Suite No
3
Use F Const Type F7
# Storiesn # Units (if Res)[7
Valuation $ 7 n J- aw
Material/Labor J
Owner's E-mail Address
Zip
State I Zip
Last
Architect/Designer's E-mail Address
Zip elephone
Architect/Designer's Address
State
City �,%lM1 -
LastFirst
_f%14t �/1--- ---
ENGINEER'S NAME
Address
City
First
iplicant's E-mail Address
..,= Telephone qr,l4Y464 - too
First F ' Lic. No. �-
CONTRACTOR'S NAME/COMPANY
Lic.
Engineer's E-mail Address /j
���/'�� Telephone Y ;flI
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771
State i�A Zip
� a Lic No. Class
Contractor's Address
State/�.
City
SETBACKS REAR �_ Q
SETBACKS LEFT
USE ZONE
Contractor's E-mail Address
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Zip / Tee,Ye� I —
SETBACKS FRONT__
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $