HomeMy WebLinkAboutX2016-3851 - Permit ApplicationX �_Oj U- 37 Sl
Worksheet for Combo Building & Solar Permit Application
F Comm'1 �sidential City of Newport Beach - Building Division
NOTE', PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
;Building F_ Grading rDrainage _',Elec (—Meth r—Plum Cu vdcutF Cu yd Fill
Project Address (Not mailing address) ❑ Flood Fire Liq Landslide �N/AFI� Suite
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Description of Work
Use Const Type
# Sto 77 # Units (if Res)
Stories �
Fi
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k 1 nd O��L G/
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Valuation $
New/Add SF F_Remodel SF�— Garage/New/Add
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Material/Labor J�,
OWNER'S NAME Last �Or�Qll� First / f rk,
Owner's Address Owner's E-mail Address
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City N('_-wf�1-Gt'6-Lh __. _-.,,I State -�� Zip _..al �j ''; Telephone
APPLICANT'S NAME Last �e 1(e / First
Applicant's Address Applicant's E-mail Address
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city Q �y-�� - -_ _- State 0q Zip��'� Telephone�yj.
ARCHITECT/DESIGNER'S NAME Last First Lic. No. (�
Architect/Designer's Address ArchitectlDesigner's E-mail Address
City State F--- Zip F-, Telephone[
ENGINEER'S NAME Last �—s 'First F Lic. No.F—'
Engineer's Address Engineer's E-mail Address
City State ! Zip �- TelephoneF_
CONTRACTOR'S NAME/COMPANY Lic. No. Class
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Contractor's Address Contractor's E-mail Address
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city 2trut)"Q State Il `t Zlp (?6� ...Telephone 7/�)a
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ `� D �� o 6