HomeMy WebLinkAboutX2015-2512 - Permit ApplicationIVY -ao/ - X075-/2-
Worksheet for Combo Building & Solar Permit Application
j"Comm'I ET] Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
jBuilding 17/Grading (Drainage fj Elec it Mech jvf Plum Cuvd Cut I Cu vd Fill
Project Address (Not mailing address) l_I Flood ❑ Fire [j Liq n Landslide i1N/A Floor
P
Suite No
Description of Work
H114vle- G4Z..A1J.61 A.v,li 'Et .) LAr-.lh'Lc A Pit
C11AtA,... j C .
New/Add SF Remodel SEE ! Garage/New/Add !
Use, 1 ConstType[
# Stories! # Units (if Resf
Valuation $
Material/Labor
OWNER'S NAME
Owner's Address
Last!....... 'IC0 ,S
City State
First! CA iZ, 't
Owner's E-mail Address
1
I..C42y,.MoQ.ks e
Zip I Telephone!
APPLICANT'S NAME
Applicant's Address
Last 1_
City
State
Zip
First
Applicant's E-mail Address
Telephone!
ARCHITECT/DESIGNER'S NAME
Architect/Designer's Address
Last !�
City
State
p
First
Architect/Designer's E-mail Address
Lic. No.
Telephone
ENGINEER'S NAME
Last
First
Engineer's Address Engineer's E-mail Address
City
State
Zi
Lic. No.
Telephone!
CONTRACTOR'S NAME/COMPANY
Contractor's Address
_
City
/� Lic. No.
LN_1713g5�i._..66-Mc
State
Contractor's E-mail Address
Class
Zip !-
! Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $