HomeMy WebLinkAboutX2015-0323 - Permit ApplicationXZ6t5 -0�2�
Worksheet for Combo Building & Solar Permit Application
F Comm'I ri Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address Not mailingaddress Moo -j Plum uyda,t� CuYdFill
PBuilding FI Grading �Dramage ❑ Elec j
i Flood [ Fire Liq Landslide �'N/A Floor Suite No
20� 22 SAMA
Description of Work
n. Use l l Const Type r I
�_ #Stories # Units (if Res)F_1
Valuation $
New/AddSFF—I Remodel SFF" I Garage/New/Add Material/Labor 1
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OWNER'S NAME Last �— First _ J
Owner's Address Owner's E-mail Address
city l �(� State [ T7 Zip F77777 Telephoned
APPLICANT'S NAME Last v C, C� First
Applicant's Address Applicant's E-mail Address
City i�>� .! —_ State Zip �2� TelephonF_/t63z_ 4
ARCHITECT/DESIGNER'S NAME LastJ First —71 Lic. No.
Architect[Designer's Address Architect/Designer's E-mail Address
City State Zip Telephone
ENGINEER'S NAME Last First l Lic. No.
Engineer's Address Engineer's E-mail Address
City J State F Zip F Telephoner
CONTRACTOR'S NAME/COMPANY l lAS I Lic No. �� J Class
Contractor's Address Contractor's E-mail Address
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City cjt1�- i'Uc�l State Zip�� Telephon Lg1fC�
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $