HomeMy WebLinkAboutX2016-4083 - Permit Application (3)Worksheet for Combo Building & Solar Permiti cation
j- Comm'I residential City of Newport Beach - Building Division
NOTE: pi nni CHECK FFFR nl IF AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood
[-I Fire F_ Liq FI Landslide CIN/A Floor Suite No
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Description of Work
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# Stories # Units (if Resf
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Valuation S
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New/Add SFio�Remodel SF
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OWNER'S NAME Last First
Owner's Address
Owner's E-mail Address
City /,�e(/7 State -ea-.
Zip 0 Telephone (7-//� %l- �-V
APPLICANT'S NAME Last First �e_ _
- - _ -
Applicant's Address
Applicant's E-mail Address
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City - /F-'c' State I Zip wi� Telepho
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ARCHITECT/DESIGNER'S NAME Last -
First s_— Lic. No. F
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip Telephones
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ENGINEER'S NAME Last �1�i'I
First �J-- Lic No.
Engineer's Address
I
Engineer's E-mail Address
City " State
ZiP n'I Telephone �% 1 f'J — 09gv
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CONTRACTOR'S NAME/COMPANY �
Lic. No.
Contractor's Address
Contractor's E-mail Address
City State f -
Telephone
Zip �i F _
SETBACKS REAR SETBACKS FRONT
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�/ \ PERMIT NO. W! fp ! fOT3
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. a0 /
-20/
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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