HomeMy WebLinkAboutX2018-3623 - Permit Application/ Worksheet for Combo Building & Solar Permit Application
Y Comm'[ r` Residential City of Newport Beach - Building Division
✓ NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ F- Fire r- Liq F Landslide FN/A Floor Suite No
Description of Work
Use Const Type F1, /}
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# Storiesi # Units (if Res) i
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New/Add SF ,�— ` Remodel SF F—Garage/New/Add F—
Valuation $
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address
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City G°.0 ed.� taQ State I " t
Zip g2Qr',0 Telephone 1 IeC % L 7 4/Z 3
APPLICANT'S NAME Last �' 0 A4 M `_ W
First 'C f 10--_
Applicant's Address
Applicant's E-mail Address
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City /V 13 /;�q
State 1 `- I
Zip _ Telephone J oo ?f1
ARCHITECT/DESIGNER'S NAME Last 1 4,0 l.t*f- Lic. No.
First o e y q
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
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City 14L/ !ue � State I d '
Zip (aV,20 ( TelephoneF?1' % Y7- P/'z- 3
ENGINEER'S NAME Last F_
First F_ Lit. No.F_
Engineer's Address
Engineer's E-mail Address
City F_ State F—
Zip— Telephone
CONTRACTOR'S NAME/COMPANY (
Lic. No. Class I
Contractor's Address
Contractor's E-mail Address
City F_ State I
Zip F-®' Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ .