HomeMy WebLinkAboutX2011-1699 - Permit ApplicationPrint Form
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Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F Building Grading F-Drainage F Elec r Mech F_ Plum CuYdCut CuYdFiil
Project Address (Not mailing address) F Flood j- Fire r Liq F- Landslide FN/A Floor Suite No
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Description of Work
Use s ConstType s
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# Stories # Units (if Res)s-
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Valuation $ (�
Material/Labor �f O D
New/Add SF� Remodel SF s Garage/New/Add �
OWNER'S NAME Last V�v'� First
Owner's Address Owner's E-mail Address
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City , (�/ State � � Zip �I Z g TelephoneF_
APPLICANT'S NAME Last yVlgGh0 First
Applicant's Address Applicant's E-mail Address
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City �— % A _ State A Zip 00�e Telephone 61 GiZ� I Lx(7
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ARCHIT'E"IC,TT//DESIIGGNN(ER(R''S NAME Last PA First F t Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City V aG � State l� Zip %jzi .T_/ Telephone VE' 7 4-2�
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ENGINEER'S NAME Last First F Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State F Zip F-- Telephoner—
CONTRACTOR'S NAME/COMPANY K1X12� �,Ae( /ONE ��{ Class
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Contractor's Address _ -� Contractor's E-mail Address
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City F— State Zip F-TelephoneArt- \/ 3( —I t7 G1
SETBACKS REAR SETBACKS FRONT PERMIT NO. X ZU 1 i
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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