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HomeMy WebLinkAboutX2017-3301 - Permit Application4OA27 Worksheet for Combo Building & Solar Permit Application eqn�(- Comml F- Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OFSUBMITTAL F-Building F_ Grading rDrainage F_Elec F_Mech F_Plum ut[- Cu Yd Fill F_ Project Address (Not mailing address) FI Fire Li e N/A Floor Suite No Description of Work Use F_ ConstType F_ # Stories #Units (if Res) v�-tYi& 1�1ds� Valuation $ �) Material/Labor y� (/ New/Add SF�— Remodel SF +. — Garage/New/Add OWNER'S NAME Last C First P vl Owner's Address Address Owner's E-mail Address city! ' ` State Zip F— Telephoned APPLICANT'S NAME Last First Applicant's Address Address Applicant's E-mail Address City State Zip Telephone q¢l�RS7 ARCHITECT/DESIGNER'S NAME Last First Lic. No. I Architect/Designers Address Architect/Designers E-mail Address City 1 e21W State I Zip I TelephoneF— ENGINEER'S NAME Last! ??e�Klzf First �J. Lic.No.F— Engineer's Address Engineer's E-mail Address &Sl r l L)u (§) 6s iF�P,� •Gave city �„� A71- State I� Zip 47070Telephone CONTRACTOR'S NAME/COMPANY „Frp\ Lic. No. �¢%Q Class Contractor's Addressss,,�j,�.-/ Contractors E-mail Address city (r--U � �-Q�- State � �- -_ �� Ste Zip Telephone �l�i `fit 376 J SETBACKS REAR S SETBACKS FRONT —L © PERMIT NO. x T SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE a ' DEVELOPMENT NO PLAN CHECK FEES $ i!v 1