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HomeMy WebLinkAboutX2016-4299 - Permit Application (2)Worksheet for Combo Building & Solar Permit Application (209 Comm'I esidentiaf City of Newport Beach -Building Division NOTP, PI AN CHECK FEES DUE AT TIME OF SUBMITTAL 11�uiiding i Grading ;Drainage FElec rMech lum cu vd cut—' Cu Yd Fill Project Address (Not mailing address) F_ Flood Fire F Liq I Landslide I. _N/A Floor Suite No Description of Work Use Const Type I # Stories � #Units (if Res)i— � i sin/© �fTTiiCf/�J a3 �Q r'i e-A�i� IPJ 941110 S� Valuation $ /�® 4 Material/Labori ®p W _ New/Add SF Remodel SF i Garage/New/Add OWNER'S NAME Last First Owner's Address Owner's E-mail Address State { City � i i _ Zip ! Telephone] , APPL/ � ICANT'S NAME Last I First Applicant's Address i I Applicanfs E-mail Address City I _ _ State F_ Zip'-- Telephone- ARCHITECT/DESIGNER'S NAME Last First �— Lic. No. Architect/Designer's Address 1 Architect/Designer's E-mail Address i City i State { Zip - Telephone ENGINEER'S NAME Last First!Lic. No. Engineer's Address i Engineer's E-mail Address I City State j Zip! Telephoned No. Class CONTRACTOR'S NAME/COMPANYLic. Contractor's Address S Contractor's E-mail Address City State-- Zip Telephoned T O. MA SETBACKS REAR SETBACKS RONT /®' CHECK NO. l S - �/ iP SETBACKS LEFT SETBACKS RIGHT PLAN L USE ZONE DEVELOPMENT NO PLAN CHECK FEES