HomeMy WebLinkAboutX2015-0717 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application (1091
City of Newport Beach - Building Division .<comm I �'Res"idential NOTE:' PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Building F-i Grading Drainage �Elec P*ech ;Plum cu vd cut �i cu Yd Fill
Project Address (Not availing address) [7 Flood C Fire [-, Liq. (° Landslide F_,N/A Floor Suite No
Description of Work {� 5 Use ConstType [�
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New/Add SF Remodel SF E}°j Garage/New/Add f -i Material/Labor
'f OWNER'S NAME Last First ��a Grn�(/J��_
Owner's Address Owner's E-mail Address �'-
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ow State Ir—C—�.� Zip (y� Telephone MAC %G_5 N3)
City (J r� �eac�_ _ L—_mil p_� � ��
APPLICANT'S NAME Last J First
Applicant's Address Applicant's E-mail Address
City PV \ �A• State' Zip lf2(p( Telephonef
ARCHITECT/DESIGNER'S NAME Last 15yo,V _ ,First JnCp�(,( J Lic.No.
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ArchitectlDesigner's Address Architect/Designees E-mail Address j
City 6JVv�Si I State I�� Zipc261A� J Telephoned_ jS7.3f?
ENGINEER'S NAME Last (yr'tv�r\ __.I First Kyy Lic. Nof
Engineer's Address Engine@.es E-mail Address
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City `� . \ll —_ _,J State Zip �Z(c 1 �' Telephone q<'� � p &. 00
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CONTRACTOR'S NAME/COMPANY ` 1F6� �� Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State Zip Telephoner
SETBACKS REAR SETBACKS FRONT PERMIT NO. XZp{ S P'Il
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. p5S7b •Zs-:l a7 .
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ I^ 1