HomeMy WebLinkAboutX2015-1197 - Permit ApplicationWQ) 01�-im
Worksheet for Combo Building & Solar Permit Application o °°a>�
Comm"Residential City of Newport Beach - Building Division _ 8
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL °<:.oa�"
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Building FI Grading F-Drainage Elec Mech �lum CurdCut CuydFill r—
Project Address (Not mailing address) F Flood [i Fire F-i Liq F-] Landslide CN/A Floor Suite No
Description of Work
Use [71 ConstType r
# Stories # Units (if Res)n
Ccfin f� -k,<K w.tG�s � <� 5..��F r�.� _ -� gv--rt-t , /.Jz•-�
Valuation $
New/Add SF Remodel SF Gara a/New/Add
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Material/Labor `
OWNER'S NAME Last ���c✓�S - - First
Owner's Address Owner's E-mail Address
City �(/�.,:,, �� ��e,State [ �-F� Zip Telephone
APPLICANT'S NAME Last(�S First
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Applicant's Address Applicant's E-mail Address
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State I- J Zip /,? 7 - o Telephone IK - X 7 j d l000
City a..� �..Lz -� C
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ARCHITECT/DESIGNER'S NAME Last First[ Lie. No.
Architect/Designer's Address ArchitecttDesigner's ail Address
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City O ra n. S2 t/c��� I State ZiP �5��.. Telephone �``�j_ (cy �,
ENGINEER'S NAME Last -_- - First F- i Lic No.
Engineer's Address Engineer's E-mail Address
City J State [ Zip r®, Telephone
CONTRACTOR'S NAME/COMPANY ,.c (/ , J Lic. No. %7c 8�� Classy
Contractor's'( Address Contractor's E-mail Address
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-- -_-- --- �� ��.q. p < 2_ 7�_ City �'l�._..,, �,�� --- State I !I Zip r—'; Telephone f�f--„27J J-l'v��
SETBACKS FRONT PERMIT NO. -` -
SETBACKS REAR (�/✓
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $