HomeMy WebLinkAboutX2016-4313 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
17 Comm'I j— Residential City of Newport Beach - Building Division �(
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
`Building r Grading F Drainage F_ Elec r Mech F-, Plum Cu Yd Cut F Cu Yd Fill F
Project Address (Not mailing
address) F7 Flood F_ Fire f— Liq F_ Landslide F_.N/A Floor Suite No
Description of Work
Use Const Type
s 7 i ve�
#StoriesF— # Units (if Res)
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Valuation $
Ma er' I{ r �`�� ��'?�
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New/A d S Ij�'�2, Remodel SF�— Garage/New/Add �1 Cj
OWNER'S NAME Last
First �j �j� �, UD
- - --
Owners Address
Owners E-mail Address 23`
City
State Zip F Telephone ,
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City
State F Zip Telephone
ARCHITECT/DESIGNER'S NAME
Last First Lic. No,
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State Zip F Telephone
ENGINEER'S NAME Last
First Lic. No
Engineer's Address
Engineer's E-mail Address
City
State Zip Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. g0?-31o"7 Class
ri %rGO�' (�✓ S i D M f7dr^ C 5
Contractor's Address
Contractor's E-mail AddressNs4 g71-02tID554
00-C-Por"A 6 -Ply
PtZc 1s p Pin Aso#- Cve-To-, K- o ne-, C-6
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City
- - - _
State l: �- Zip q2(o (, v Telephone 9'4, r .- 7Z3 / 800
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. ..
USE ZONE
DEVELOPMENT NO s ® PLAN CHECK FEES $
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