HomeMy WebLinkAboutX2016-4274 - Permit ApplicationWorksheet for Combo Building &Solar Permit Application
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F— Comm1 Residential City of Newport Beach - Building Division o `
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F_Grading (Drainage j—Elec rMech
F—Plum Cu vd cut- Cu Yd FiO�
Project Address (Not mailing addres t ood
r Fire Li r Landslide f N/A Floor Suite No
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Description of Work
Use 3�� Const Type vs ,
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/.�#k Units (if Res)
Valuation
New/Add SFF Remodel SF � Garage/New/Add �—
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OWNER'S NAME Last /[q¢,� FirstI /?*'r'(
Owner's Address
Owner's E-mail Address
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City r—�-- / State I
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Zip 9� Telephoone
APPLICANT'S NAME Last z„ �TL✓
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First �Z�IiG
Applicant's Address
Applicant's E-mail Address
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City State F �-
Zip 9� Telephonel
ARCHITE DESIGNER' NAME
First 1)4-�--4 Lic. No.�
Architect/Designees Address
Architect/Designees E-mail Address
City Late
Zip � Z` TlephoneF — Z ` b
ENGINEER'S NAME Last �
First F_ Lic. No.F_
Engineer's Address
Engineer's E-mail Address
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City State I r
Zip �— Telephoned 0 S —1 rv,�
CONTRACTOR'S NAME/COMPANY /� Lic. No. /U 319 Classy
Contractor's Address
Contractor's E-mail Address Frg on? 3 6 (Po
City _ ��.. n. �. _ State
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Zip _Gj7� (P> L� Telephone 9 l �/ q 3 �( C GPI)�1
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. Yq I
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Vq33 ' Zp 7p
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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