HomeMy WebLinkAboutX2015-2624 - Permit ApplicationdR63-2065 X20/5-A62y
pri,t Form Worksheet for Combo Building & Solar Permit Application gr6"°°Ra
[- Comm'I [-Residential City of Newport Beach -Building Division 'tom l
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[-Building [-Grading [—Drainage [-Elec [-,Meth [-Plum curdy jw cuvdFillF -
Project Address (Not mailing address) [- Flood r— Fire [- Liq [- Landslide [-N/A Floor Suite No
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Description of Work
Use F— ConstType
# Stories[- # Units (if Res)F_
W1,47 -r. r•4,9.
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Valuation $
New/Add SF to Remodel SFI Gara a/New/Add 2
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Material/Labor �
OWNER'S NAME Last �— First
Owner's Address Owner's E-mail Address
City _ State �— Zip F—' Telephoned_-,
'APPLICANT'S NAME Last
Applicant's Address Applicant's E-mail Address
City � State �—' Zip F Telephoned.
ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designees Address Architect/Designer's E-mail Address
City I State F_ Zip F--. Telephoner
ENGINEER'S NAME Last �— First F Lic. NoF .
Engineer's Address Engineer's E-mail Address
City State F Zip F—; Telephoned.
CONTRACTOR'S NAME/COMPANY Lic No. F_ Class r—
Contractors Address Contractor's E-mail Address
City State F_. Zip F— Telephoners�
SETBACKS REAR SETBACKS FRONT PERMIT NO. �CL'(L✓�L`c
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 161(L
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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