HomeMy WebLinkAboutX2016-1177 - Permit ApplicationPrint Form Worksheet for Combo Building & olar Permit Application
❑ Comm'I ❑Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building ❑ Grading ❑Drainage ❑Elec ❑Meth ❑ Plum Cu Yd CutF7 Cu Yd Fill s
Project Address (Not mailing addrea
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Description of Work
❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
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Use Const Type s
# Storiess # Units (if Res)C
New/Add SF Remodel SF 6 I Garage/New/Add
OWNER'S NAME Last .�-��V21N�TQ� First
Owner's Address Owners E-mail Address
ISM e�e� ��L1D LA�JE_
City State ® Zip jb Telephonen4f�jjm 01
APPLICANT'S NAME Last
First
Applicant's Address Applicant's E-mail Address
— i
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City State � Zip Telephone
ARCHITECT/DESIGNER'S NAME Last First
Lit No.
Architect/Designer's Address Architect/Designees E-mail Address
City State Zip Telephone�i
ENGINEER'S NAME Last ( First F-777] Lit No.F_
Engineers Address Engineer's E-mail Address 0,—) S.�l_Z"
3i (
City State Zip F Telephoned
CONTRACTOR'S NAME/COMPANY �. 12�NE U C Lic. No. Class
Contractor's Address Contractors E-mail Address
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City ��.VlNL State Zip 60� Telephone"1i
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
PERMIT NO. Y)a Inn
PLAN CHECK NO. ol'o -ul
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $