HomeMy WebLinkAboutX2016-1160 - Permit ApplicationRwhs- y
Print Form Worksheet for Combo Building & Solar Permit Application o,,�N e
r Comm'I f7 Residential City of Newport Beach - Building Division ff tt
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 7� Iq
r�Building r7 Grading
,F-Drainage 7'Elec rMech F Plum CuvdCut F CuuYYdFill j.`a
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Project Address (Not mailing address) r Flood F_ Fire j-, Liq r- Landslide Floor Suite No
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Description of Work
Use I di r Const Type
S I
# Storiesr2 # Units (if Res)F_
New/Add SF ' 7'„&9
Remodel SFF— Garage/New/Add -7,97
Valuation $
Material/Labor F/,G0, 0,
OWNER'S NAME
Last
Owners Address.
Owner's E-mail Address
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city
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State p
Ctt, Zip �/78N Telephone
zip
APPLICANT'S NAME
Last First
Applicant's Address
Applicant's E-mail Address
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CiGrGC /' y_1 ✓'•xiointVG/. lNs Conn.
City C
State C_A Zip CI17st t Telephone ,4,7 7om. Z118V
ARCHITECT/DESIGNER'S NAME �j Lic. No. a
Last v First
3 6
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Arch itect/Designer's Address
Architect/Designer's E-mail Address
City ewPo✓^b ntacA
State Cfi Zip `,'Z6C. Telephoner.//a,v54;.:77iy L( J37fW
ENGINEER'S NAME
Last nn First �- Lic No.F_
a
Engineer's Address
Engineer's E-mail Address
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City r d �wc�
State Zip %Ziy3 Telephone
CONTRACTOR'S NAME/COMPANY A Lic. No. F_— ClassF
Contractor's Address
Contractors E-mail Address
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City corn �m6' 1 _Imar
State C_A Zip %° b �s Telephone ivy. 7/5 i736
SETBACKS REAR
SETBACKS FRONT PERMIT NO. Z-01 G - (I D
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. C � U�
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $ la tD I ��
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