HomeMy WebLinkAboutX2017-1900 - Permit Application (2)Print For Worksheet for Combo Building & Solar Permit Application
r Comm'I f! Residential City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F , Flood j- Fire 17, Liq r Landslide
New/Add SF Remodel SFF Garage/New/Add
OWNER'S NAME Last I Eb�o i , de i U_L First
Cuu�Yd Fill
IA Floor Suite No
Use ConstTypel • V
# Stories # Units (if Res)'
Valuation a
Material/Labor
Owner's Address
Owner's E-mail Address
City ` I tj State CA Zip I tf I L�101. 4� Telephone(/ L;
APPLICANT'S NAME Last �� %�1L`,C_ First
Applicant's Address
City, State F
Zip
Applicant's E-mail Address
I T Telephone ��
ARCHITECT/DESIGNER'S NAME Last P?t 1
� "v \ First
Architect/Designer's Address
1-79 <, l o ✓1 ✓ L�tti�
City L State
Lic. No. r'K L Q/.
Architect/Designer's E-mail Address
Zip Telephone I1 Z f Z `
ENGINEER'S NAME Last T� t �U% P First F— Lic. Nap z 533
Engineer's Address
city A _ State
Engineer's E-mail Address
es/�E.acv_
Zip I
q-7770( TelephoneF7 l�[`-z&��CD
CONTRACTOR'S NAME/COMPANY�t j v , 1 b yn S Lic. No. ( C ss�
Contractor's Address
City f State
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
Contractor's E-mail Address
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Zip /I y_ l _ f fi Telephone pVa,-�Zl�C,-
PERMIT NO.
PLAN CHECK N0,
PLAN CHECK FEES $ �'