HomeMy WebLinkAboutX2016-2882 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o� Oqq-
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City of Newport Beach - Building Division
Comm'I
NOTE: PLAN CHECK FEES DUE AT TIME OF SURMITTAI
�Lilding ❑Grading [Drainage ❑Elec f—Mech Plum CurdCut l 1 CuYdFill
17
Project Address (Not mailing address) l- Flood F Fire F_ Liq (—, Landslide F_N/A Floor Suite No
tia IS NTr4
F F_
Description of Work
Use Const Type C'
# Stories # Units (if Res)s
New/AddSFF_ RemodelSF77
Valuation $ ��
Garage/New/AddF� Material/Labor 3 ��,
OWNER'S NAME Last �U [,L>' \ �1l
First I1/l�-
Owner's Address
Owner's E-mail Address
UL
City 6JNE IJState Zip %too Telephone 7—ti— �j— Q
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City -- State
Zip F Telephone��
ARCHITECT/DESIGNER'S NAME Last
First
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip Telephoned
ENGINEER'S NAME Last
First—Lic. No.�
Engineer's Address
Engineer's E-mail Address
City State F_—
Zip F Telephoned
CONTRACTOR'S NAME/COMPANY
Lic. No. ClassF7
Contractor's Address
Contractor's E-mail Address
City State F
Zip Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 2n2
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $