HomeMy WebLinkAboutX2015-0829 - Permit Application (2)Worksheet for Combo Building & Solar Permit Application orpW�R �
Comm'I :Residential City of Newport Beach - Building Division OA -16. 0 9
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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g Grading �Draina e XElec Mech jp Plum Cu Yd cutF cu vd Fiiil
Project Address (Not mailing address) [I Flood r Fire F, Liq F Landslide Lr;N/A Floor Suite No
Description of Work Use r 71 ConstType
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# StonesF # Units (if Res)r
f ,01A -l— 273 3P NEw 694Rflel,>
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Valuation $
New/Add SF f 2•ij ,y"F I Remodel SF 2.y9lo% 1 Garage/New/Add �i'OSPI Material/Labor
OWNER'S NAME Last First % Owner's Address Address Owner's E-mail Address
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City ���/_ 2� State C�}- J Zip ��'2�p-v�.�rj
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APPLICANT'S NAME Last /lam//� k -//✓ j First f C O
Applicant's Address Applicant's E-mail Address
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City 1416W
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ARCHITECT/DESIGNER'S NAME Last 1���j/�% _ J First -Tc 4? 1 Lic. No. 9-$39 $7
Architect/Designer's Address Architect/Designer's E-mail Address
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city 45W/OvAr ,ggy� l State I��� Zip X12 G(o of Telephone ?!�O _ v FF
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ENGINEER'S NAME Last �i1%�E/Q��� - __. FirstFDA l/,C_ Lic. No. C $(pyD
Engineer's Address Engineer's E-mail Address
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TelephonCitv j�lr State Zip -J2(/S�9y�$87-�'i2,7
CONTRACTOR'S NAME/COMPANY �� 7 - - Lic. N4 Class
Contractor's Address Contractor's E-mail Address
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city State Zip �7�j7j' J Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO,. p.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. d�31 •%ol�
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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