HomeMy WebLinkAboutX2016-3199 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Per A plication
❑ Comm'I ❑ Residential City of Newport Beach - Buildicl
ng Division Xr%O�� A !,A
NOTE: PLAN CHECK FEES DUE AT TIME OF SUB I -�KL �(
kJBuilding ❑ Grading ❑Drainage �ec
Project Address (Not mailing addre:
Description of Work
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❑ Flood ❑ Fire ❑ Liq ❑ Landslide
❑N/A Floor Suite No
I it
Use F7 Const Type C
# StoriesC # Units (if Res)C
Valuation 0011
New/Add SF � Remodel SF � Garage/New/Add F1IMaterial/Labor /
OWNER'S NAME Last �ij)(Sort /hP}q1 f l yt t Sin r yl9 j First
Owner's Address Owners E-mail Address
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City Ngu/ State
f! lir zip 92�,/ Telephone W/TP,72& i
APPLICANT'S NAME Last F/1—ix—s I t FI 1/�� �h First '.
Applicant's Address Applicant's E-mail Address
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City 172ack State'; Zip 82663 Telephone %O
ARCHITECT/DESIGNER'S NAME Last L6 fakfm o a - -1-__—_ J First S UM i+ Lic. No. C 37
Architect/Designer's Address
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City Q 6 TA State L 6 l '
Architect/Designer's E-mail Address
Zip q�63V Telephone gu yiyr j" i/U
ENGINEER'S NAME Last COLO , k` (7 J First ��1ya�'d 0 J Lic. No. C 7773_;
Engineer's Address
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City e -�i State C
rEngine�per's E -/mail Address
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Zip 9��® Telephone
CONTRACTOR'S NAME/COMPANY �" Lic No. CZ Class
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Contractor's Address
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City Pf ; r — --_ State _eW
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractors E-mail Address
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Zip 925® Telephone 951565 6355:
PERMIT NO.
PLAN CHECK NO. Z-7,z�lgz" 101
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $