HomeMy WebLinkAboutX2016-2538 - Permit Application (2)`Priptm� Worksheet for Combo Building & Solar Permit Application o"a
F] Comm'I esidential
City of Newport Beach -Building Division X�Ol6-R53$
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL IM"
P;Jfruilding [7] Grading [7Drainage ❑Elec ❑Mech ❑,Plum Cut vdCut
F7 CuvdFill
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Project Address (Not
mailing address) E] Flood ❑ Fire ❑ Ligq ❑ Landslide ❑N/A Floor Suite No
t l �O A2(G c4,2 V yf C1
Description of Work
TUse Const Type
C , # Stories # Units (if Res)❑
Valuation $
New/Add SFF_1_7___7, Remodel SF f (, Q I Garage/New/Add Material/Labor
OWNER'S NAME Last I `tFirst 2«�
Owner's Address Owner's E-mail Address
l l L t i� � 2lc �, Jac t r � � � �tna.1 � ••{}.�.,�,�", Co M
city State (�jLt,} State Zip F7 Telephone
APPLICANT'S NAME Last � First Ls-S
Applicant's Address Applicant's E-mail Address
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City LRr;U,,� W`� tj I State C.rF Zip Telephone CAZ Z_ C.7a Z
ARCHITECT/DESIGNER'S NAME Last First E Lic. No. �!
Architect/Designer's Address Architect(Designer's E-mail Address
city,.j945LT GJA I State Zip (ZCS Telephone 6 T)
ENGINEER'S NAME Last First � Lic. No.
Engineer's Address Engineer's E-mail Address
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I
City ! State Zip Telephoned
CONTRACTOR'S NAME/COMPANY,�i . „'�, ��" �L0�5 Lic No. Class
Contractor's Address ��•�•c� Contractor's E-mail Address
City 's'�- �_� ! State Zip( Telephone f
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $