HomeMy WebLinkAboutX2015-1662 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
F -I Comm'I residential City of Newport Beach - Building Division
TE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �+;Poaa•
B.6!jding Gradingta'Ina/g Elec Mech Plum CuvdCutF YdFillProject
Address (NIng address) [J Flood C Fire [ Liq ❑ Landslide /A Floor Suite No
Description o�f! Work %
Use[_ ]
ConstType
�W 36 &! /T 6 ! � ' I
# Stories[f
# Units (if Res)
Valuation $
Material/Labor
g o o
Jew/Add S I del SF Garage/New/Add I
1
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0WWE1k'SAAMxT1WLast �� �(�� 9)t/ J First J
,Owner's AI dtlress Owner's E-mail Address, I ,
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City�� — ��_ I State Zip ` Telephone 7�p
APPLICANT NIAME Last - Q�f r� A0,; J First z'
ApplicantaA cress Applicant's E-mail Address
—D� n ,lie%
City6 -/f $tate FCA Zip Telephoned�
ARCHITECT/DESIGNER'S NAME r
First-_ =Lic. No..
Architect/Designer's Address Architect(Designer's E-mail Address
City State Zip jjG3 TelephoneF___7
ENGINEER'S NAME Last/ 4 I� -1 First J Lic. No:
Engineer's Address Engineer s E-mail Address
City ��yJ jd State t✓,� J Zip j 7 p J Telephone �� Z S-2 0
CONTRACTOR'S NAME/COMPANY � (hN�l Lia No. (kz ClassF&71
' ,
Contractor's Address Contrac or s E-mail Address
1sal_ 1 0"A C 0 �-
_
City _� State Zip Telephone
SETBACKS REAR SETBACKS FRONT _ PERMIT NO. 0)
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $