HomeMy WebLinkAboutX2016-3880 - Permit Application (2)Worksheet for Combo Building & Solar Permit Application
Comm'I Residential City of Newport Beach - Building Division F
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �a
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Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
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Description of Work b�
Use Const Type
# Storiese # Units (if Res)
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New/AddSFF—,---
Remodel 1iF
Garage/New/AddF J
Valuation $
Material/Labo
OWNER'S NAME Last CR oSS
First'
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Owner's Address Owner's E-mail Address
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City NQwPCP—t" tge-Ac:ll State ep- Zip
Telephone
APPLICANT'S NAMELast
First
Applicant's Address Applicant's ' E-mail Address
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City J state F-7 Zip Telephone
ARCHITECT/DESIGNER'S NAME Last First
Lic. No.
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'. Architect/Designer's Address -' Architect/Designer's E-mail Address
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City State Zip
Telephones
ENGINEER'S NAME Last l First [� ZL� J Lic'No.
-Engineer's Address : -> Engineeesr E-mail Address
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.City �— _, _ I State Zips
Telephone—I
CONTRACTOR'S NAME/COMPANY sN G0aSTI'ueflD Lic. No: �'i3661 Class
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Contractors Address ' Contractor's E-mail Address
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.� City I.A(�Un� /V\G EL_ State G.,A Zip
671 Telephone gLrs' i1D—/77'
SETBACKS REAR SETBACKS FRONT PERMIT NO. eO� b
ETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
_77T �T /
$E ZONE DEVELOPMENT NO PLAN CHECK FEES $