HomeMy WebLinkAboutX2016-2021 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'I sidential City of Newport Beach - Building Division cl
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F- Grading FDrainage FElec F-Mech F Plum uYd Cuts Cu Yd Fili s
Project Address (Not mailing
addres lood F_ Fir Li j— Landslide f N/A Floor Suite No
Description of Work
Use s(?=onstType
# Stories # Units (if Res)s
Valuation $ m
New/AddSF� Remodel SFE—:T�-7— Garage/New/Adds—
Material/Labor 5�_
OWNER'S NAME Last
��—l—�L�First
Owner's Address
Owner's E-mail Address
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City NrL ,y� r p`k� --- State -_--- Zip - `� v�J�-- Telephone 'L a4/ Zq6 "ice J
APPLICANT'S NAME Last U� ('� -- First -
Applicant's Address
Applicant's E-mail Address
i[�s
p,l/�a�� cal , r Iz c � I �, CO
City N 43 .
State _. C1- Zip a j y� Telephone;; " 5
ARCHITECT/DESIGNER'S NAME
Last First Lic. No. F
Architect/Designers Address
Architect/Designer's E-mail Address
City I
—
State F-- Zip F— Telephone
ENGINEER'S NAME Last First 7 Lic. No.
Engineer's Address
Engineers E-mail Address
City I
State F_ Zip F— Telephonel—
CONTRACTOR'S NAME/COMPANY Lic. No. F-- Classs
Contractors Address
Contractor's E-mail Address
City
State F— Zip F_ Telephones
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $