HomeMy WebLinkAboutX2016-3345 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
r Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j—Building [Grading [Drainage F_Elec j Mech F_Plum CuvdCut CuvdFit F
Project Address (Not mailing
address) 1— Flood F_ Fire [- Liq F- Landslide [N/A Floor Suite No
6%0 —IA—A�(Lv
F_ I_
Description of Work
Use l �� ConstType
~,)rz- fuq�QiL kpq
�;WIOY IZM 2,0 5-r l 40-vVr-w &A(&4bE
# Stories # Units (ifRes)F_
Valuation
New/Add SFFJ rlL Remodel SF Garag a/New/Add I G
Material/Laa bor
OWNER'S NAME Last I
0"-o-j q-z First I tNOMA
Owners Address
Owner's E-mail Address
lS5t7 Poicwwe9 5•r.
Awl®P t7CM�
City w L-AA D
State F7_ - Zip kj 7 Y Telephone l(f 1 %fl2 24{R4
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City
State F__ Zip F'. Telephone
ARCHITECT/DESIGNER'S NAME
Last 64A /44 First 6_ lCjL Lic. No. Dl (, 1
ArchitectIDesigner's Address
Architect/Designers E-mail Address
City I t�Cnn.{'b,r
State F(� Zip Ct LZO Telephone �Itf lFg� 331.5
ENGINEER'S NAME Last
First-- Lic. No.F—
Engineer's Address
Engineer's E-mail Address
City
State —. Zip Fe TelephoneF
CONTRACTOR'S NAME/COMPANY
A * M p cvr,l,Q e/1,¢Y r Lic No. F_ Class Ir -
Contractor's Address
Contractor's E-mail Address
city
State �— Zip-- Telephoned
SETBACKS REAR
SETBACKS FRONT PERMIT NO. l
-RACKS LEFT
SETBACKS RIGHT PLAN CHECK N . o7'f(p - 9,01(,
iNE _
DEVELOPMENT NO PLAN CHECK FEES $ 2D