HomeMy WebLinkAboutX2018-3572 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
F Comm'I NResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F Grading F-Drainage F-Elec FMech
Aplum CuYdCut r curdFill r
Project Address (Not mailing address) F_ (— Fire j— Liq jr Landslide 1_N/A Floor Suite No
Description of Work
Use O 4 Const Type
op
# Stories # Units (if Res)�—
Valuation $
Material/Laboril�j�
New/AddSF— 1 RemodelSFrGarage/New/Add `
OWNER'S NAME
Last bf&A *40(w �
W4 First
Owner's Address
�
_ Owner's E-mail Address
7M t I ---
City
State F'
Zip !sO - TelephoneF
APPLICANT'S NAME
Last
First
Applicant's Address
Applicant's E-mail Address
City I
State I
Zip F— TelephoneF—
ARCHITECT/DESIGNER'S NAME Last F_
I
First F— Lic. No.
I
Architect/Designers Address
Architect/Designer's E-mail Address
City
State F—
Zip v Telephoners
ENGINEER'S NAME
LastF_ e,,�—
First Lic No.! I
Engineer's Address
Engineer's E-mail Address
City
�'— State F_
Zip Telephoner,____
CONTRACTOR'S NAME/COMPANY I
I
Lic No. qq 1� �ClassF
t' 1
Contractor's Address
Contractor's E-mail Address
City r� �
State r--u
Zip r�®a- Telephone)-_
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. Y4AL%
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. %,(.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $