HomeMy WebLinkAboutX2016-1155 - Permit ApplicationPrint FormWorksheet for Combo Building & Solar Permit Application ocd °tea
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City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading rDrainage �,c chd/ _ /Plum Cu vd Cut Cu Yd Fill s
Project Address (Not mailing address) rFlood r Fire r Liq r Landslide rN/A Floor Suite No
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Description of Work
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Use r � 1 ConstType ly
#Stories #Units (if Res)s
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Valuation $
Material/Labor ✓ 0i nv
New/Add SF�— Remodel SFF77 Garage/New/Add F—
OWNER'S NAME Last . t✓�L��V. _ First _ , 0rfI _.. I.�. 1 ClM 4— j
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Owner's Address Owner's E-mail Addresrsa �' 1 /Y-il .1 b
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City I1—�
State F— Zip Telephone S {O -I $� • '`} 0 6
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APPLICANT'S NAME Last(AL1DyrFirst 4201
Applicant's Address Applicant's E-mail Address
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City 1� � o l .or i{� State (; Zip �'�,�(y ( Telephoner ZI cl - A 0 o-- I Cj 34
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ARCHITECT/DESIGNER'S NAME
Last e_ First
�C2_l�,�C?(�' Lic. No. G_'l�}6li�J
Architect/Designer's Address Architect/Designer's E-mail Address
City State F— Zip F_ 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 r`� G �I Lic No. r Class
Contractor's Address Contractor's E-mail Address
City State Zip Telephoner
SETBACKS REAR SETBACKS FRONT PERMIT NO. ( r
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $