HomeMy WebLinkAboutX2016-3854 - Permit Applicationably- 3g5 -y
Worksheet for Combo Building & Solar Permit Application
F Comm'] Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F wilding F- Grading
j -Drainage F-Elec F_Mech (- Plum cu Yd cut_7 Cu Yd Fill F-1
Project Address (Not mailing address) F_ Flood F- Fire F Liq [—.' Landslide CN/A Floor Suite No
Description of Work
Use F_ Const Type F
#Stories #Units (if Res)
Valuation $
New/Add SF
Remodel SF�— Garage/New/Add ,
Material/La 0
OWNER'S NAMEA
0 J
Last /''''�- _.. First
Owner's Address
Owner's E-mail Address
City � yQ'__-_
_. State -' Zip U....-TelephoneO5 7�j-D'_p
APPLICANT'S NAME
Last , ( r� First
v
Applicant's Address
Applicant's E-mail Address
-- 4
-
City _ t'V � 0
_.. I� State Zip '1 4/.. _�li Telephone
d t'J 3�,�'. 7
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. F—',
Architect/Designees Address
Architect(Designer's E-mail Address
City
State F— Zip F Telephone
ENGINEER'S NAME
Last First F Lic. No.
Engineer's Address
Engineer's E-mail Address
City
State Zip F TelephoneF
CONTRACTOR'S NAME/COMPANY1 `M /� �� Lic. No. 9D/J ^ Class
J (• �-s
Contractor's Address
Contractor's E-mail Address
O(I 64 x,. L
-.
_/
City /7J D ��
State Zip /6' Telephone
- -- - I / o ' 7
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SETBACKS REAR
1
SETBACKS FRONT '2%0 PERMIT NO.
SETBACKS LEFT S 2
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE Sf>ut�DEVELOPMENT NO PLAN CHECK FEES $