HomeMy WebLinkAboutX2016-1016 - Permit Application (2)X'LO 1� - lO l to
Worksheet for Combo Building & Solar Permit Appiication gre,
j Comm'I r Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j—Building r -Grading r -Drainage rElec r-Mech FPlum Cu Yd aitF cu Yd FtllF
Project Address (Not address) C Flood F Fire F- Liq r- Landslide f N/A Floor Suite No
/mailing
Description of WorkkJ
Use Const Type F
StoriesF_ kUnits(ifRes)F—
Valuation $
New/Add SFF— Remodel SF I— Garage/New/Add r
Material/Labor
OWNER'S NAME- Last /CUJ—v�C�� First
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Owner's Address Owner's E-mail Address
City � _ State F— Zip F— Telephoned—.
APPLICANT'S NAME Last qn _ First��(/Y
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Applicant's Address Applicant's E-mail Address
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city!l�'o''T✓Y .> State F` Zip Telephone'
ARCHITECT/DESIGNER'S NAME Last^—_ First �— Lic. No.
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Architect/Designees Address Arch itect/Designees. E-mail Address
City State Zip Telephone
ENGINEER'S NAME Last (/��'//� First 444 v✓0 Lic No.r---
_ _ _
GIL/� of 28f
Engineer's Address Engineer's E-mail Address _
3�J513 e:WM1..449 GA,P1_ST..AP.1v #0JZ
CilyS,AJ/ JLh;� Gi9�p/S7J�✓4/UQ� State �� Zip (— Telephone...��-g) 2 �%U' ,� ZJ 73
CONTRACTOR'S NAME/COMPANY Lic No.F__Class
Contractor's Address Contractor's E-mail Address
City r--- State F Zip Telephone--
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SETBACKS REAR SETBACKS FRONT DSI ERMITNO. 6 -00)
SETBACKS LEFT SETBACKS RIGHT Rlrahl CHECK NO.
USE ZONE PLAN CHECK FEES $ Sn o, 2),!a
DEVELOPMENT NO
CITY CIF turf y pp -1"t 13LIAQ1
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