HomeMy WebLinkAboutX2016-3174 - Permit Applicationx20110 -- 311 y
Worksheet for Combo Building & Solar Permit Application (��asqpwa
F Comm'I Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building I— Grading rDramage cMech Plum cuvdCut cuvdFin F
Project Address (Not mailing address) a0lood F- Fire F_ Liq F_ Landslide f_N/A Floor Suite No
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Description of Work
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# Stories #Units (if Res) (�
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Valuation $
Material/Labor
New/Add SF Remodel SFprvarage/New/Add !
OWNER'S NAME Last Nan_ First V,_190' (5 v
Owner's Address (O..
Owner's E-mail Address
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City _ i*' State (_" Zip 72,123, Telephone -L/' j�`
APPLICANT'S NAME Last First
Applicants Address Applicant's E-mail Address
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city State r Zip Pho �e
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ARCHITECT ESIGNER'S NAME Last First I blP4,4--Lic. No.I
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Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip / r Telephon
ENGINEER'S NAME Last {t{y(4j__ First;z - Lic. No. Piss
Engineer's Address Engineer's E-mail Address
City State F Zip F ._ Telephoner - —
CONTRACTOR'S NAME/COMPANY j Lic No. F_ Class r—
Contractor's Address Contractor's E-mail Address
City I---- _.. _ _ _ State r_ Zip F_, Telephone_.,
SETBACKS REAR SETBACKS FRONT PERMIT NO. ^ IN f b
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO: 4-t b - Z0 I {o
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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