HomeMy WebLinkAboutM2018-0079 - Permit Application (2)I�tiGUg — 00779 RAF rk� q- 2TI y
Pn4torm ' ? Worksheet for Combo Building & Solar Permit Application
Comm I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) ❑ Flood F7 Fire � Liq rl Landslide ❑N/A Floor Suite No
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Description of Work Use ConstType
# Stories�# Umts (if Res)
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Valuation
rGarage/New/Add�Materal/LaNew/Add SFF Remodel SF bor
77
OWNER'S NAME Last GKV 1W C Cts W A Ny ..i First '
Owner's Address Owner's E-mail Address
City T r v r n e Stade__ Zip Fj:Telephone
APPLICANT'S NAME LastQ((�hq�-IIXryv hK1hrlC� First �ti1rYl I�
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Applicant's Address Applicant's E-mail Address
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City _p t.X O(1 I v 1 Zip 92.69____ Telephone--®1.-�- `(� (.� 2 -
State
ARCHITECT/DESIGNER'S NAME Last 1 First - Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City ...... _.-. State ...
_- �— �'��, Telephone
- -- Zip
ENGINEER'S NAME Last ��C,Lh� ,(-On First ra t"� •� Lic.No. s iq n
Engineer's Address Engineer's E-mail Address
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CONTRACTOR'S
-QNAME/COMPANYIW4Lic.No.1_442,V7 Class
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Contractor's Address Contractor's E-mail Address
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SETBACKS REAR SETBACKS FRONT PERMIT NO. l a 00)
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO 1 / J�'PLAN CHECK FEES $
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