HomeMy WebLinkAboutX2015-0513 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
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012 NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G<.o••'
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Project Address (Not mailing address) ❑ Fplood �i Fir L q Landslide [N/A Ftttlo✓✓✓or��` Suite No
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Description of Work V
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# Stories # Units (if Res)
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Valuation $
Material/Labor
New/AddSFF Gf7 �� Remodel SFF Garage/New/Add
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OWNER'S NAME Last tr}� First/gyp Q
Owner's Address Owner's E-mail Address
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city I State EF Zip Telephon 0
APPLICANT'S NAME Last FirstWW ..IV-V-t----- ---
Applicant's Address Applicant's E-mail Address
City V ] State I—V� J Zip f Telephone
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ARCHITECT/DESIGNEP,'SNAME Last i First' Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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ENGINEER'S NAME Last %,rye J First °� I - Lic. No. /Z_! �7
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Engineer's Address Engineer's E-mail Address
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CONTRACTOR'S NAME/COMPANY �•� "-CCA" Lic. No. 5i'3053 Class
Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ 9,
Print Form Worksheet for Combo Building & Solar Permit Application o4rE�R>m
j Comm'I4�esidentlal City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL `'"a•�"
rBuilding F_ Grading rDrainage rElec F_Mech
rPlum cuvdCut cuvdFiuF
Project Address (Not mailing address) r- Flood
r Fire r Liq I- Landslide rN/A Floor Suite No
S �t�rzE v� V�
Description of Work
use F—ConstType F
# StoriesF #Units (if Res)
Valuation $ Poo
Material/Labor
New/Add SF 2��p� Remodel SF� Garage/New/Add
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OWNER'S NAME Last
First J `,IA 6
Owner's Address
Owner's E-mail Address
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City DU__ State �—
Zip F—TelephoneF—
APPLICANT'S NAME Last �Ac C Z�"nj
First 0- 6-� V) t s
Applicant's Address /
Applicant's E-mail Address
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City GJO� �"' / // State CRJ
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ARCHITECT/DESIGNER'S NAME Last First �— Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City I State F_
Zip F_ TelephoneF_
ENGINEER'S NAME Last
First F_ Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State F_
Zip F_— Telephoned
CONTRACTOR'S NAME/COMPANY t,t�„ , Lic No. 13 D� 7� ClassFli
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Contractor's Address
E-mail Address
City -c0s Tom- '�j��! State e
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. y a.0 157
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 1) 40D "" v1 nI S
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $