HomeMy WebLinkAboutX2016-4083 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
j City of Newport Beach - Building Division
Comm'[ Vesidential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
uilding F- Grading rDrainage lec F_Mech
j- Plum cuYdCut F CuYdFill
Project Address (Not address) F_ Flood
r Fire i- Liq r" Landslide FN/A Floor Suite No
mailing
GZ�,6 ��1-114 L
Description of Work
Use �7 ld ConstType
# Stories #Units (if Res)�g
T�
A«
Valuation $
Material/Laborl��r'���111
New/Add SF 7ps F, h' Remodel SFFj Garage/New/Add ---
OWNER'S NAME Last First A_C.1_ .
°�C
Owner's Address
Owner's E-mail Address
e'er G 'E_ Z^ /L
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City [ �� State rta
Zip .Z Telephone (f7/y) '' G�.
APPLICANT'S NAME >!
Last G' C� 'fir First C� -.,) -(-y
Applicant's Address
Applicant's E-mail Address
City State ��t
Zip Telepho ( .3r'J.76, Z, c� .
ARCHITECT/DESIGNER'S NAME Last
First I Lic. No.
Architect/Designers Address
ArchitectlDesigner's E-mail Address
Ar
I
F_-
City �-®—®- State F_
Zip I_ Telephoner—�-
ENGINEER'S NAME Last f W _
Firstr� }'�-- Lic No. Ul
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Engineer's Address
Engineer's E-mail Address
City State FW _
Zip MIl Telephonevti1' (%.b�q
v_
CONTRACTOR'S NAME/COMPANY 7 I�Z?C' r -
Lic No. ClassF__
Contractor's Address
Contractor's E-mail Address
City State F__
Zip r_ Telephoner—
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. X S61 -{OT3p
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
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USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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