HomeMy WebLinkAboutX2016-0432 - Permit Application (3)Print Form !414orksheet for Combo Building . Solar Permit Application MA
city of Newport Beach -Building Division
j Comm'I jf Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL a"'t
F Building (J Grading FDrainage F_ Ele.c-eech F_ Plum Cu Yd Cut cu Yd Fill
project Address (pilot mailing address) iJ Flood I— Fire j` Liq [_ Landslide f N/A Floor (�JteeN
F t 5 � 5 N
Description of Work
RA.•trVt� la 1 Lam. V L
New/Add SF15U-j- Remodel SFF —
UseFFR Const Type �/
# Storied # Units (i Rese
- Valuation $ 17�
Garage/New/Add �Material/Labor f
OWNER'S NAME Last I First
Owner's Address Owner's E-mail Address
City State Zip Telephone
APPLICANT'S NAME Last ( First
Applicant's Address Applicant's E-mail Address
City F State C Zip,F Telephone
ARCHITECT/DESIGNER'S NAME Last G. N R 1 -' -�
G • J �_.� (,- EST First 1 t ( tt j Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
CS? u Pr l
City 'JL.wfRV-f &A(* State I <<'' Zip ?24..6v Telephone '°f�j10691 -6_)-4
ENGINEER'S NAME Last Lic. No, First
T,y--�- __,_-.---__------
Engineer's Address Engineer's E-mail Address
City State F__ Zip F Telephonee(n- Lm (,�5A
CONTRACTOR'S NAME/COMPANY f Lic. No. F_ ClassF
Contractor's Address
City State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
F_ -
Zip _9;�e.�`.f Telephone
PERMIT NO.
PLAN CHECK N
PLAN CHECK
FEES $
m �: