HomeMy WebLinkAboutX2016-3685 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application oF'E='�a'a
❑ Comm'I ❑ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building ❑ Grading ❑Drainage ❑ Elec ❑ Mech
❑ Plum CuYdCut l CuvdFill F_
-71
Project Address (Not mailing address) ❑ Flood
Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
Description of Work
Use ConstType -/
ra,161 6
# Stories # Units (if Res)
Valuation $
Material/LaborF;/
d�
New/Add SFRemodel SF _� Garage/New/Add
OWNER'S NAME Last l�%b First phVrO
Owners Address
Owners E-mail Address
C�r�7c�s c 1�
City/ State
Zip
Zip Z� Telephone
APPLICANT'S NAME Last C�� First
Applicant's Address
Applicant's E-mail Address
S90 moo- Cites? lLcly 7�l�''
�/�drsl- hInfry•cal
City r&/ A A%3r / State I /7.MJ�
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Zip 5'�� Telephone �C 3��"3 "7
ARCHITECT/DESIGNERR'S�N'iAME� Last '��j�,�
First gi-_- Lic. No.
Architect/Designers Address
Architect/Designers E-mail Address
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,�iF2�@ C s��/v+�2r • Cavt,
City State I 7 "
Zip �' J-"JI. Telephone gW_ a%( i 5 3,�
ENGINEER'S NAME Last 1/5
First � Lic. No. G o¢o
Engineers Address
Engiin�eeer's E-mail Address
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City any°/A" t/ . - State W_
Zip _Ll�'�/ Telephone �T/� -((8�r'(j'�p
CONTRACTOR'S NAME/COMPANY /7 Cw) .S[l ,[ Lic. No. lass
Contractor'sAddddrreysss�/
Contractors E-mailAddress
/1907 �Q/-r Cr-1
city yµ/�J`CT State 0177
Zip �r / Telephone �7� �V
SETBACKS REAR SETBACKS FRONT
PERMIT NO. /\I
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $