HomeMy WebLinkAboutX2016-2208 - Permit ApplicationXZOW - ZZ01
X2D((o —2208
Worksheet for Combo Building & Solar Permit Application
❑ Comm', esidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
FIB Grading ❑Grading rainage ❑Flet ❑Meth ❑Plum cuvdcutF cuvdriuC
roject Address (Not mailing address
1a NL'a L's
escription of Work
Ci k C vvl 2u v a
❑ Flood C Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
77
New/Add SFRemodel SF
F_77�!'; Garage/New/Add
OWNER'SNAME Last d4uv First
owners Address Owner's E-mail Address
City PO'I�T State I � Zip 77D TE
APPLICANT'S NAME Last/t,/ S ,., t First
Appli nt's Address
City State �II
se C Const Type F-7[
Stories17 # Units (if Res)C
Applicant's E-mail Address \"
Zip 42G,go Telephone - �' ob..'
ARCHITECT/DESIGNER'S NAME Last First 7_ ', Lic. No. E_
Architect/Designer's Address
City _ _ State—�,
Architect/Designers E-mail Address
Zip TelephoneF_7 �
ENGINEER'S NAME Last First�I Lic. No.r.
Engineer's Address
City State �—
Engineer's E-mail Address
I
Zip I Telephone F__
CONTRACTOR'S NAME/COMPANY p�j M�f< Lic. No. Class
Contractor's Address
City �h r _ ji€� State
SETBACKS REAR SETBACKS FRONT
Contractor's E-mail Address
Zip 2p'30 _ J TelephoneF7--/ /— 2� Y
PERMIT NO. A Y110 I L- 2
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USED NEr In _ DEVELOPMENT NO �p1 (o" �` PLAN CHECK FEES $