HomeMy WebLinkAboutX2016-2595 - Permit Application`HEEHED Worksheet for Combo Building & Solar Permit Application
Comm'( Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[Ouilding Grading [Drainage ec ech /�
LTrltlm Cu Yd Cut❑ Cu Yd Fill ❑
Project Address (Not mailing address) [ Flood [ Fire [ Liq [ Landslide [N/A Floor Suite No
L 15 S Naz — 0
Description of Work
i Jf- Use ❑ ConstType ❑1
d oCG 7
5 rXemodflr # Stories # Units (if Res)
New/Add SF�i Remodel SF (Valuation $
Garage/New/Add Material/Labor
OWNERS NAME
Last �n1i'�'1 [�- First Q�.iUn
Owner's Address -
Owners E-mail Address
�r
IS
y S csSl i__ i
Cit L�LG of State /�� -
Zip ��. Telephone
APPLICANT'S NAME Last Al !
First S
Applicant's Address -
Applicant's E-mail Address
City �—
t• L State LL kL_J� Zip 0Telephone
ARCHITE ER'S NAME
Last LC% - First`
J Lic No. -�Z�—
Architect/Designers Address Architect/Designer's E-mail Address
771S c6 4L
City I� II�C�L, State //'� +
ZiP �G Telephone
�FTGINEER'S N11➢E Last j �----
Jnu Cn First 5 Lic.No.
Engineer's Address Engineers E-mail Address-��-��—
_i?li�
City
State I ! A Zip _f�0� Telephone
! `--R-- 33r z3
CONTRACTOR'S NAME/COMPANY
Lic No.,pQ Classl
Contractor's Address Contractor's E-mail Address D U3S�P
t'V LcCity State Z
p Telephon
'
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. U
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $