HomeMy WebLinkAboutX2016-3920 - Permit ApplicationVYorksheet fpr Combo Building & Solar Permit Application
r Comm'I esidenti�l City of Newport Beach - Building Division ..
NOTE: PLAN CHECK IFEESr DUE AT TIME OF SUBMITTAL
uiding rGrading Drainage [jElec F-,,Mech :FI Plum mvdCutF77 cuvdFill17
Project Address (Not mailing address)'C Flood '� Fire ❑ Liq [ Landslide �N/A Floor Suite No
Description of Work Use' L ' Const Type �I
# Stories # Units (if Res)
aluatio �'1
New/AddSFF Remodel SF —,j �C�ara Mater? /Labor L
OWNER'S NAME Last First
L 7Z
Owner's Address H2_ IJ_L
Owner's E-mail Address'
�D.6' olR.cish�lr�
qi
e1 State Telephone
< y�j 2
Zip n //.� - P
APPLICANT'S NAME Last�i �n First -r jOP*r
Applicant's Address Applicant's E-mail Address
City _ StaA te I / ,/� Zip Telephone y t ,••Z'% �/► —11 Ll
ARCHITECT/DESIGNER'S NAME Last - ` � First � l Lic. No. �I
- ,
Architect(Designer's Address Architect/Designer's E-mail Address
City StateF Zip F Telephone
ENGINEER'S NAME Last First. �,VL
rEngineer's Address Engineer's E-mail Address
City t<rIpJCT Stater Zip' Telephone
CONTRACTOR'S NAME/COMPANY F Lic. No J Class
_ ---` — --
Contractor's Address - : Contractor's E-mail Address
City State F Zip E Telephone
V_�j�
SETBACKS'REAR / SETBACKS FRONT / PERMITNO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 1rZ6
USEZONE DEVELOPMENT NO PLAN CHECK FEES $