HomeMy WebLinkAboutX2016-1826 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
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City of Newport Beach - Building Division a
r Comm'I (— Residential NOTES PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_Building (- Grading F-Drainage F_Elec f-Mech
I- Plum CuydCut F CuvdFill F
Project Address (Not mailing address) F_ Flood
F- Fire r Liq f- Landslide (-N/A Floor Suite No
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Gf?_ LS F
PAMP/xj J,m ((jWA 0-
mAL GA I
Description of Work
Use F—ConstType
# Stories #Units (if Res)
Valuation $
New/Add SF� Remodel SFF Garage/New/Add
F_—
Material/Labor FI1c`�
OWNER'S NAME Last K�}l4ut_I
First I AA5z,A
Owner's Address
Owner's E-mail Address
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A" k4ALiue/AZ .�aM
City State F—
Zip[— Telephone 310-z3'o-61-TG
APPLICANT'S NAME Last Srnti
First
Applicant's Address
Applicant's E-mail Address
City F_ State �—
Zip F_ TelephoneF—
ARCHITECT/DESIGNER'S NAME Last
First F Lic. No. F
Architect/Designer's Address
Arch itect/Desig ner's E-mail Address
h�N'y(£uti� In!'f%S�f
City State F_
Zip F_ TelephoneF—
ENGINEER'S NAME Last Aw
First ( # - l71n/6 Lic No.,
I,e
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Engineer's Address
Engineer's E-mail Address
City State �
Zip _ f_,T S Telephone glrt-z(,0 3tz`/
CONTRACTOR'S NAME/COMPANY U+,13��n`n Lic.No.F ClassF
Contractor's Address
Contractor's E-mail Address
City State F—
Zip F— Tele hone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. i
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $--�—Ila L