HomeMy WebLinkAboutX2018-1668 - Permit Application (3)Print Form Worksheet for Combo Building & Solar Permit Application o��FW°°qTe
dial City of Newport Beach - Building Division
r Comm'I n Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) ❑Flood U Fire F 1 Liq /j L(an�d^sii�de Floor Suite No
Description of Work 3 beck 4 b -eOl \
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Use 77 Const Type
# Stories # Units (if Res) _
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Valuation $
New/Add SF �j Remodel SF t� Garage/New/Add I Iv Material/La
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OWNER'S NAME Last ` f 1 g �F— _� First
Owner's Address Owner's E-mail Address
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City Lk r) CL beat td State CA Zip q 2 Cps ( Telephone S(2)Sty" S S .
APPLICANT'S NAME Last I �/�rr> J First
Applicant's Address Applicant's E-mail Address
City `—� State Zip F_77 Telephone
ARCHITECT/DESIGNER'S NAME Last '1 lei First yy��((��,,.,,� i� i . I Lic. No.
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Architect/Designer's Address Architect/Designer's E-mail Address
City —_ State i� Zip TelephonV �___1 o� ,• % 7�
ENGINEER'S NAME ✓ Last First Lic. No.
Engineer's Address Engineer's E-mail Address
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City I State Zip ',i Telephone
CONTRACTOR'S NAME/COMPANY Lic. No. F Class
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Contractor's Address Contractor's E-mail Address
City State �- Zip �� Telephone
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SETBACKS REAR
SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
PERMIT NO. n( 170M
PLAN CHECK NO.
PLAN CHECK FEES $