HomeMy WebLinkAboutS2016-0193 - Permit Application (2)S2o16 - 01g3
Worksheet for Combo Building & Solar Permit Application10
City of Newport Beach - Building Division
[- Comm'I Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL `'11,Ri
[-Building [-Grading [—Drainage [-Elec [-Mech [-Plum CuvdCut F CuvdFill F
Project Address (Not mailing address) C Flood [- Fire [- Liq
[- Landslide CN/A Floor Suite No
Description of Work
Use Const Type
# Stories # Units (if Res)[—
1
Valuation $
New/Add SF�— Remodel SF�— Garage/New/Add Fi
Material/Labor
OWNER'S NAME Last ��4 First
Owner's Address Owner's E-mail Address
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City State Zip F Telephone —'
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
��sem. �s ,cY 2(m �� �r LaAcy
V�5z1s� ►�, � c��
City �„�I_ ���� State F Zip��
Telephone
ARCHITEVCTTIDESIGNER'S NAME Last �e�s , p First F
--
Lic. No. F—
Architect/Designees Address Architect/Designer's E-mail Address
AV A -c j�
City State I Zip F
Telephone
ENGINEER'S NAME Last r6v C First—
11
Lic. NoT
Engineers Address Engineer's E-mail Address
city v '' It t iw State 704--1lZip 9 05-7Telephone
�` L I � 3CJ -6 /,CID
CONTRACTOR'S NAMEXOMPANY e0Cha
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Lic. No. ZClass
Contractor's Address Contractor's E-mail Address
`_?-03-7Z_ �krivtliNk
City I GW _ / �_ i�Ls�t'_ State ;� _ Zip 2_630
Telephone _ ® Q 7 /fi7n S -61z _—GS J
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN "CHECK FEES $ `