HomeMy WebLinkAboutX2016-3727 - Permit Application`/-2G&-7__.27Z7 Z,''? owsP
Worksheet for Combo Building & Solar Permit Application ro 06M
Comm'[ Residential City of Newport Beach - Building Division fsG �p^'
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL S-W&(2)
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Project Address (Not mailing address) F-(' Flood [- Fire ❑ Liq F7 Landslide A Floor Suite No
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Description of Work Use F71____1 Const Type
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# StoriesCl # Units (if Iles)[
S I i Valuation a
New/AddSF�� Remodel SF '%Q Gara a/New/Addl Material/Labor 1 •0• Atl0
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OWNER'S NAME Last First
Owner's Address - Owner's E-mail Address
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APPLICANT'S NAME Last /t/ (ry -7" First P R `L/ - 4 BR % A N
A pplicant's Address Applicants E-mail Address
City .State L Zip l J Telephone
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ARCHITECT/DESIGNER'S NAMELast (' L S Q N First J�/; V L Lic. No. G i ( Z-(r (
Architect/Designees Address '` Architect/Designees.E-mail Address
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City State �— Zip Telephone %i
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ENGINEER'S.NAMEp ' Last C G V R First ; - Lic. No. �^
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,Engineer's Address Engineer's. E-mail Address
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City State F_j Zip Telephone fg �+'i
CONTRACTOR'S NAME/COMPANY L(O Lp� l� t -� C Lic. No. �/ 3 Class F7
Contractors Address ( Contractor's E-mail Address
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City r4ti� State zip R Z-7o1' Tale{ihone MT:0 0
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $