HomeMy WebLinkAboutX2017-3892 - Permit ApplicationL Pr� Worksheet for Combo Building & Solar Permit Applica on
F CommI Residential v v t/ (
City of Newport Beach -Building Division �%,91 �J� �j 9
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMItfAL
Wes.-
KBuilding (� Grading
r-Drainage F Elec F_ Mech F Plum Cu Yd Cut F_I Cu Yd Fill
Project Address (Not mailing address) F.. Flood F_ Fire [_ Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use F Const Type C
# Stories[ # Units (if Res)
�1,F nti A
Valuation $ 101000,0a
Material/Lab
New/Add SF
Remodel SF Garage/New/Add
OWNER'S NAME Last F First
Owner's Address
Owner's E-mail Address
City
State F Zip F— Telephoned
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
City �
State � Zip F_ Telephones
ARCHITECT/DESIGNER'S NAME Last First F� Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
F
City ( -
State Zip �� Telephoned
ENGINEER'S NAME
LastW� First Lic. No.
Engineer's Address
Engineer's E-mail Address
City �
State F Zip F_ Telephone
—CONTRACTOR'S NAME/COMPANY �� G o �6 Lic. No. F77 37a o Class r
Contractor's Address
Contractor's E-mail Address
woo fQ�na�� 15�;� Uo �� Dev(oYne.30 ynas1, cots
cjerCt
City I � �o �j
State (�� Zip �Q Telephone 11't-313.1M
SETBACKS REAR �
SETBACKS FRONT l �/� PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. .o;L O
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $