HomeMy WebLinkAboutX2016-3859 - Permit ApplicationPrint Form `T11 Worksheet for Combo Building & Solar Permit Application
[ Comm'I �esidenti I'Y 3� �1 City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding C; Grading
roject Address (N
,Drainage Klec _ ch Plum
❑Flood Fire f7
I Liq
Cu Yd Cut Cu Yd Fill
[� Landslide r _N/A Floor Suite No
New/Add SF� Remodel SF7 �_
Garage/New/Add
Use ; Const Type F7
# StoriesF7 # Units (if Res)
(Valuation$ �(f
.— Material/Labor
OWNER'S NAME Last �G�Z� First
Owner's Address Owner's E-mail Address
City ��/ fJUl� J �j� State Zip �?7 Telephone v 9T 7`z, —(7496;
APPLICANT'S NAME Last
Applicant's Address
State
ARCHITECT/DESIGNER'S NAME Last
Architect/Designees Address
City -- C lZ C --- —j State—',
First
Applicant's E-mail Address
Zip
First Lic. No.
Architect/Designer's E-mail Address
I
Zip ,��6 � s Telephone��
ENGINEER'S NAME Last First Lic. No.
Engineer's Address
City �s State
Engineer's E-mail Address
Zip � Telephoned'
CONTRACTOR'S NAME/COMPANY i7� j�J �,_ f1 — ic. No. �jI� C
Contractor's Address L Contractor's E-mail Address
City V% _ State Zip %G�Telephone Vr 9(
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $