HomeMy WebLinkAboutX2016-3838 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
Comm'I [Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
,WBuilding F Grading r`Drainage lec Mech ❑ Plum Cu Yd Cut Cu Yd Fill �
Proiect Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq [ _ - Landslide
Description of Work T
f ✓Yle ter; c� �LVyc-C c- SS - �� - l J C.C. 1�^
New/Add SF Remodel SF 3o�o fq:F Garage/New/Add
OWNER'S NAME Last uit- � First AL J I r)
Owner's Address
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city E� ���T 1�
IN/A __. Floor
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Suittee No
Use Con stType 77
# Storiesr— # Units (if Res) Aj
Valuation $
Material/Labor
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Owner's E-mail Address
✓t LMS I(u LTII a o,),t-!5 & C- L1�_�C_�
State ® Zip
Telep
APPLICANT'S NAME Last � � First I #kL\J- 0
Applicant's Address Applicant's E-mail Address
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L ___ — 1
City ___7 State Zip F—7 Telephone
ARCHITECT/DESIGNER'S NAME
Architect/Designer's Address
City
ENGINEER'S NAME Last
Last First Lic. No.
Architect/Designer's E-mail Address
State �® Zip Telephone
First
Engineer's Address Engineer's E-mail Address
City State Zip TelephoneF
CONTRACTOR'S NAME/COMPANY
Contractor's Address
Lic. NoT- - -
Lic. NoT Class
Contractor's E-mail Address
City State F_— Zip � — Telephone, _
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE: DEVELOPMENT NO PLAN CHECK FEES $