HomeMy WebLinkAboutX2016-2027 - Permit ApplicationWorksheet for Combo Building & Solar Permit A pli .on �Ew
[� Comm'L Residential
City of Newport Beach - Building Division
+ NOTE: PLAN CHECK FEES-DUE AT TIME OF SUBMITTAL ,� v
Building- ❑Grading ❑Drainage_ �Elec 'RMech rum cuvdCut CuvdFill
Project'Address.(Not mailing address)❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Fl
Suite No
Description of Work D 1, A0 i6s. Const
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#Stories #Unit
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New/Add SF: , Remodel SF Gara a/New/Add Material/Labor
OWNER'S NAME Last est First
Owner's Addres§Owners E-mail Address
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City N n/J7. G'tkc4E� -State �' .: 'j, Zip 2 Telephone CW__� '
APPLICANTS GAME ' {+ " , Last �aor1BS First �=(
Applicant'¢ Address .°. , Applicants E-mail Address ,% '
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City—� State e Zip �2 ? p Telephone _ Z (a
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ARCHITECT/DESIGNER'S NAME Last _!X%,'�g First T Lic. No. G 41 f
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Architect/Designees Address Architect/Designees E-mail Address
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City State lam_✓_T--! Zip `127 Telephone 1 _Z%O' ^ D Z
ENGINEER'S NAME Last' First 1, LS Lic.. No. 4Q
EngineePsPddres$ , i —Engineers E-mail Address
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Ob n/( co
City �n) A/� State Zip O ' Telephone
CONTRACTOR'S NAME/COMPANY \ Lic. No. Cla
Contractor's Address rn °I Contractor's E-mail Address
Cit St to Zi Tele hone
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SETBACKS REAR SETBACKS FRONT 710� PERMIT NO. -
- SETBACKS LEFT ,(D SETBACKS RIGHT Cor PLAN CHECK
USE ZONE^ (^ 1�0-0 DEVELOPMENT NO PLAN CHECK FEES $