HomeMy WebLinkAboutX2016-3660 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application *21E
City of Newport Beach - Building Division
❑ Comm'I ❑Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL16 ^ 3(rifo0
❑IBuilding ❑ Grading
❑Drainage Elec Mech Plum cuvdcuin= cuvdFiu
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Project Address (Not mailing address) ❑Flood _j Fire ❑ Liq ❑ Landslide N/A Floor Suite No
F-7 F71
Description of Wor
Use, Const Type F
# StoriesC <# Units (if Res)F
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New/Add SF92—�_�
�Valuation
R mo eIIF Garage/New/Add l I
$
Material/Labor <D�60-3
AWNER'SNAME
Last _ First .rl dt
-. Owner's Address
-Owner's E-mail Address
City s
J ..State L �7 Zip F I Telephone
APPLICANT'S NAME
Last �uv I �� (b First L10'• ^
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Applicant's Address
Applicant's E-mail Address
L3,2-4 04 J 0
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City
State L J Zip' Telephone 11 t - J
ARCHITECT/DESIGNER'S.NAME Last First ' Lic. No.F_1
ArchitectIDesigner's Address Architect/Designer's,E-mail Address
:City
I
j State �� ZipTelephone
ENGINEER'S NAME
Last First F1 Lic. No.
,,Engineer's Address
-.: Engineers E-mail Address
J
City
State zip Telephone)
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CONTRACTOR'S NAME/COMPANY Lic. No.34Z Class
Contractor's Address
Contractor's E-mail Address
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/
Yj4t�S r f
City _
- C
Stater Zip Telephone
ETBACKS REAR
SETBACKS FRONT PERMIT NO.
ETBACKS LEFT
[USE
SETBACKS RIGHT PLAN CHECK NO.
ZONE
DEVELOPMENT NO PLAN CHECK FEES $ d '/