HomeMy WebLinkAboutX2018-3657 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
J" Comm'I (` Residential City of Newport Beach - Building Division
NOTE: ,PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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➢'`Building F_ Grading ('Drainage Elec FMech
/Project
F-PlumCu Yd Cut F_Cu Yd FillF_
Address (Not mailing address) I- Flood
r Fire r Liq F_ Landslide J_N/A Floor Suite No
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Description of Work
Use F_ Const Type
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# StoriesjF # Units (if Res),
Valuation
Material/La o
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New/Add (,�g Remodel SF Garage/New/Add!r
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OWNER' Last I' A`
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First
Owners Address
Owners E-mail Address
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City State
13
Zip Gri Telephone
APPLICANT'S NAME Last I �VeS�Cr�
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First 0 ) s — -
Applicant's Address
Applicant's E-mail Address
City I i-otot State I (X—
Zip otx / Telephone 7/_ 3
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ARCHITECT/DESIGNER'S NAME Last �-
-
First F_mo Lic. N(o..`
Architect/Designer's Address
Architect/Designers E-mail Address
City _ State
Zip Telephone,
ENGINEER'S NAME Last (
First �, j'x Lic No. '3�3 6 q
Engineer's Address ,.
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Engineers E-mail Address
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City ' f I / ,A
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Zip _ Telephone! Qlll 4/Lit a L�n
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CONTRACTOR'S NAME/COMPANY L �e
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Lic No. I501 [8 Class, ti
Contra(ctctor's Address ,��,�
oContractorr''s�E-mail Address
city �(1.VVhe- State 6
Zip_dP�—VTelephoneFX ?-C7aS3 cP`l
SETBACKS REAR v_ SETBACKS FRONT
', PERMIT NO. M
SETBACKS LEFT SETBACKS RIGHT � , L PLAN CHECK NO. �(�.('� \ �? .� IS 66
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USE ZONE DEVELOPMENT NO �/l�L�
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-6S7 7PLAN CHECK FEES $