HomeMy WebLinkAboutX2015-0907 - Permit ApplicationZ o k 5 —0"107
Worksheet for Combo Building & Solar Permit Application
F_ Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F -Building [Grading Drainage F_Elec rMech F -Plum Cu Yd cute Cu Yd rills
Project Address (Not mailing address) � Flood r Fire f- Liq � Landslide i�N/A Floor Suite No
Description of Work Use ConstType
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f 1 #Stories #Units (if Res)
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Valuation $
New/Add SF�-- Remodel SF� Garage/New/Add �— Material/Labor PIG;
OWNER'S NAME Last First '
Owner's Address Owner's E-mail Address
City I� State 1 Zip_-- ZsJ Telephone V�i-_?9Y ^7
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APPLICANT'SNAME Last I First
Applicant's Address Applicant's E-mail Address
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City Mra—] S — State J Zip T .7� Telephone ?_�Qe '3
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ARCHITECT/DESIGNER'S NAME J First / (� Lic. No. C-1 7q0 C
Last DSL J ���
Architect/Designer's Address Architect/Designees E-mail Address
City State Zip[ �� �... I Telephone c (_J�
ENGINEER'S NAME Last - ��/� I Firstrind l Lic. No. j —&-7
Engineer's Address Engineer's E-mail Address
City �jUIY� lf� _ J State--_v� Zip Telephone
CONTRACTOR'S NAME/COMPANY C �r C� \� .4�- Lic. No. Class
Contractor's Address Contractor's E-mail Address
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city e� �G.•k �.��. State) Zip Q%?Lb 2 l Telephone �KQ•G`t`t
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO 2
USE ZONE DEVELOPMENT NO ` PLAN CHECK FEES $