HomeMy WebLinkAboutX2016-1037 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Applica#,on
r Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r_ Grading (-"Drainage r Elec r Mech r Plum CuYdCut FZ7
Project Address (Not mailing address) [_ Flood r Fire r` Liq r-" Landslide
31x?
Description of Work x !�) f z UY !�
New/Add SF Remodel SF Garage/New/Add F—
OWNER'S NAME Last I (j� First
Owner's Address
City U -5/ ,4 al 0-TT State 526 2-5-
APPLICANT'S NAME Last I r9M
r
Applicant's Address
City N P!%lAI� State
Cu Yd Fill I G/
[_N/A
Floor Suite No
else F— Const Type
# Storiesu # Units (If Res)
Valua
Mates
Owner's E-mail Address
Telep�6ne �la��s�
First
Applicant's E-mail Address
Zip �' 2,c Telephone � / ( 376 2124;
ARCHITECT/DESIGNER'S NAME Last -�" GL 165 mru' st Lic. No. 1,!:�%pZ_
Architect/Designer's Address Architect/Designer's E-mail Address
City I State �— Zip �— Telephone
ENGINEER'S NAME Last ��/(_.-_ First
l G��1lV � Lic. No.r>T
Engineer's Address R3 E 20<7y�
f EPW�V-
City s7� 4P< ' State
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City, + 7`C, t _ State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Engineer's E-mail Address
ZipF��ee2:�7 Telephone
Lic. No. �C�f/��i� Class j
Contractor's E-mail Address
Zip 2336 Telephone 9jr/-z;5 %G/C,
PERMIT NO.X11 I0j aol �03�
PLAN CHECK NO.
PLAN CHECK FEES $