HomeMy WebLinkAboutX2016-4206 - Permit Application (2)Worksheet for Combo Building & Solar Permit Application
j Comm'I (� Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
`Building I� Grading F-Drainage 5l Elec 17( Mech
/Project Address (Not mailing address) F Flood
3o1 Ui•a-�11_r_7;,dv
Description of Work
F>u. A
New/Add SF
I io ""V
Remodel
j�PlUrn CuYdCuti CuYdFill
F_ Fire F_ Liq F_ Landslide [_N/A Floor Suite No
12,
Garage/New/Add t f
OWNER'S NAME Last F �rs 4e 1 � First I C�3
Use I Const Types
# Stories? # Units (if Res)?
Valuation $/17
!�0j5
Material/Labor /
i� CE
Owner's Address / Owner's E-mail Address
i F-
'it'
Y Se_ w(>b ✓4 Beech- State I �� Zip ! ��6,1Telephone
APPLICANT'S NAME Last j
Applicant's Address
�Je2�g
City acv�a�� /� / State C'
ARCHITECT/DESIGNER'S NAME Last i l
Arch itect/Designe'ss �Address
City /VI?Wji/7 - - - State I0 -
First
Applicant's E-mail Address
Zip i ,?� 66 Telephone 7 C f,? . � ;7q_6�-5-
First IT", Lic. No.
Arch itect/Designer's E-mail Address
Zip i C��v Telephone
ENGINEER'S NAME Last j J�� 2q tf First / f Lic No.��®�
Engineer's Address (� Engineer's E-mail Address
City �� �� State (�1 Zip �'l�v� Telephone �� .
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City I. (U� �P` /, State
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
ITCI_4�ell __tovee�
Contractor's E-mail Address
Lic. No. �Pn" Class I F
Zip' q(0q7 Telephone116M , �'®o 91916
X1-6r6 (4�
PERMIT NO. �\GU<O - `�U
PLAN CHECK NO.�� �0
PLAN CHECK FEES $