HomeMy WebLinkAboutX2016-4286 - Permit ApplicationX1�ol�.
Worksheet for Combo Building & Solar Permit Application oF�`
City of Newport Beach - Building Division Y 2,cv((.— �, r& o �
F— Comm'I<Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j�uilding XGrading F—Drainage�Elec N"Mech plum Cu YdCuth
Project Address (Not mailing address) f— Flood F— Fire F- Liq F_ Lallndslic
Description of Work
NewAdd SF / RemodelSIFF Gara /Add rao
yecy IIm I-C-
GWNER'SNAME Last FIrstlr�T'
Owner's Address Owner's E-mail Address
City % i/State �' Zip Telepho
APPLICANT'S NAME Last
First
Cu Yd Fill
Floor Suite No
UseT3 k Const Type
# StoriesT,--' # Units (i1
Valuation 5 /'
11
Material/Labor
Applicant's Address Applicant's E-mail Address
City _ State I Zip F— Telephoned
- 5�F3
ARCHITECT/DESIGNER'S NAME Last hL� First �i Sf� No. �7�
tl
ArchitectlDesigner's Address - Architect/Designer's E-mail Address
City ,/jam.. ,wee®!� State 1�i/ Telephone;�", '7'%Q.- 0.tj6,�
ENGINEER'S NAME LastF/Vwi7,75_/r� First C Lic•
Engineer's Address - Engineer's E-mail Address
City �A,�I iG Jj._. a/� ,^�%_ State Zip i�� Telephone - P..
CONTRACTOR'S NAME/COMPANY ✓ / Lic. No. F— Class
Contractor's Address Contractor's E-mail Address
City tvt6g, &�� — Zip [_ Telephone�_
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $