HomeMy WebLinkAboutX2015-3660 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application QN,
City of Newport Beach - Building Division
r Comm'I ResidentialNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing addresso�ood r Fire V/Liq F Landslide f N/A Floor Suite No
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Description of Work
Use FP—ConstTypeF
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# Stories #Units (if Res)
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Valuation s
Material/Labor 2 �'
New/Add SFF— Remodel SFF Garage/New/Add
OWNER'S NAME Last my /17
' First C fh,,4
Owner's Address
Owner's E-mail Address
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Zip 6/ZctipU Telephon i
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APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State F_
Zip r Telephoned
ARCHITECT/DESIGNER'S NAME Last �—
First F__ Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City _ State F
Zip F Telephoned.
ENGINEER'S NAME Last
First F_ Lic, No.�
Engineer's Address
Engineer's E-mail Address
City State 7—.,
Zip �— Telephoned --
CONTRACTOR'S NAME/COMPANY Lic. No. �— Class
/V iv (ion s:-- V CA-t a,
Contractor's Address
Contractor's E-mail Address
City State F
Zip F Telephone�-
SETBACKS REAR SETBACKS FRONT
PERMIT NO. x 2 Q 15 — A -a (PC/
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. -
USE ZONE DEVELOPMENT NO
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f-5
PLAN CHECK FEES $ 1pl0
Print Form Worksheet for Combo Building
f— Comm" Residential City of Newport each Building
�p �iPo Permit
Application
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
-VFBuilding r Gradinn
Project Address /N
III Z \ V)O
of Work
rDramage jv,,Elec
6 7-k, —f
r Mech r Plum cued
r Flood r Fire r Li r
q r Landslide
N
New/Add SFF — Remodel SFF�
Garage/New/Add F�
OWNER'S NAME
Last
Owner's Address - - First
Owner'sAddress
Cu Yd Fill I
rN/A Floor
— � SuiteI
IUse Const Type
# Stories # Units (if Res
�F
Valuation $
Material/Labor �� �Jq0
City I --_.__---- _ _._. I
State �—
Zip l Telephone��—
APPLICANi'SNAME
Last
5 fI BKlfa ft>I/ First Applicant's Address
(�U N Applicant's E-mail Address
City
-� State I G6l Zip F—'..
ARCHITECT/DESIGNER'S NAME
Address
bX
City
ENGINEER'S NAME
Last
��(Jj3 Last Telephone FOS
l�
irs
Architect/Designer's E-mail dress
' State 1�
Engineer's Address First I
Engineer's E-mail Address
Lic. No f __ —
City I --- I
State �— Zip F 1'elephoneF---
CONTRACTOR'S NAME/COMPANY
if/5 �iLr GGTic✓ti
Contractor's Address - -/✓— _ Lic. No.
____._._ - Classy Q
Contractor's E-mail Address
City
State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
— USEZONE SETBACKS RIGHT
DEVELOPMENT NO
Telephone --
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $