HomeMy WebLinkAboutX2015-1521 - Permit Application (3)Worksheet for Combo Building & Solar Permit Application O4$Ew>Dae
Comm'I r Residential City of Newport Beach -Building Division j(ZolS , Ift l o ?
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building F_Grading
F -Drainage F_Elec F_Mech F-PlumCu Yd CutCuvdFill
Project Address (Not mailing address) F_ Flood F- Fire r- Liq r- Landslide i -N/A Floor Suite No
Description of Work
Use Const Type
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#StoriesUnits (if Re)F
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Valuation $
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New/Add SFI �
Remodel SF Garage/New/Add �i
Material/Labor
OWNER'S NAME0'
Last - First LL C
Owner's Address
Owners E-mail Address
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CitY State C�—_I Zip Z.Gb3. Telephone ._i`I_ 1 5 `f W
APPLICANT'S NAME
Last First J
Applicant's Address
Applicant's E-mail Address
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City
State Zip C.I"� Telephone T�`r 757--6Z.16
ARCHITECT/DESIGNER'S NAMELast. First.. Lic.No.
Architect/Designer's Address
Architect/Designer's E-mail Address
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City
State Zi q t Telephone
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ENGINEER'S NAME
Last-- First �a-- — Lie No.�
Engineer's Address
Engineer's E-mail Address
City-- _ --
-f State ---I Zip �W� Telephone
CONTRACTOR'S NAME/COMPANY I Lic. No. Class E
Contractor's Address
Contractor's E-mail Address
City
State; Zip Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO,
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES
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