HomeMy WebLinkAboutX2016-2779 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
❑ Comm'I a residential City of Newport Beach - Building Division
NOTES PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building ❑Grading F-Drainage j—.Elec ❑Mech ❑Plum CuYdCutJJ � CuYdFill l
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Project Address (Not mailing^^ address) ❑Flood ❑Fire ❑ Liq ❑Landslide ❑N/A Floor Suite No
Description of Work Use 7 ConstType
# Stories i f # Units (if Res)❑
Valuation'$
New/Add SF�� Remodel SFF[-------71t� Garage/New/Add 0 Material/Labor
OWNER'S NAME Last .� 3 (�,.lJ�r'/Vi��j,C,� First j
Owner's Address Owners E-mail Address
City
I�t.r]
State
�
Zip
Telephone
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State E77 Zip _::_7 Telephonel
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City _ State Zip Telephone
ENGINEER'S NAME Last First Lic. No.F77—_
Engineer's Address Engineers E-mail Address
State F-1 Zip F Telephoned
CONTRACTOR'S NAME/COMPANYVW0 Lic No. Class
Contractor - - Contractor's E-mail Address
City j State �� Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $