HomeMy WebLinkAboutX2016-0958 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
Comm'I r Residential City of Newport Beach - Building Division
�.22, NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Cy
[]Building rGrading Drainage .Flet QMech ]Plum cuvdcuc— cuvdFlii1
Project Address (Not mailing address) Flood Fire iq Landslide ❑N/A Floor Suite N
Description of Work 4kaLoWUsen Const Type
(YA AQ
# Storiesn #Units (if Res
-_...
Valuation $
New/Add SFF Remodel SF —i Garage/New/Add F77-71 Material/Labor W�a l
OWNER'S NAME LastFirst:
Owners Address Owners E-mail Address 411 J,
CityState �� Zip �� Telephoned
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
_ ___ _ _
City State F___7 Zip 'j Telephone
ARCHITECT/DESIGNER'S NAME Last First—) Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip F-71 Telephoned
ENGINEER'S NAME Last _ J FirstF Lic.No.177-7
Engineer's Address Engineers E-mail Address
.... - .
I
-,City State F 7_71 Zip:) Telephone
CONTRACTOR'S NAME/COMPANY Lit. No. � Class
Contractor's Address Contractor's E-mail Address
--- -- ----- -------- --
City State L Zip � Telephoned
-SETBACKS-REAR - SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT -NO PLAN CHECK FEES $