HomeMy WebLinkAboutX2016-1078 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r'; Comm'I r Residential City of Newport Beach - Building Division X to l la -1075
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NOTE: PLAN CHECK FEES DUE AT TIMF OF SI IRMITTAI
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Description of Work
User Const Type
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# Storiesf—il # Units (if Res)F—
Valuation $ e
Material/Labor
New/Add SF�— Remodel SF�— Garage/New/Add �—';
OWNER'S NAME Last IG.VSc Q�-
�y1UG'S}"M ' First ��� �e ��
Owner's Address Owner's E-mail Address
City ILS ty�tl.✓�,.J.._.� State l ��
rc;r Zip I Telephone��D.
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APPLICANT'S NAME Last ..... ___ First
Applicant's Address Applicant's E-mail Address
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City W,,4-m',0-� ,. State Zip Telephone��
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ARCHITECT/DESIGNER'S NAME Last First F Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip Telephone
ENGINEER'S NAME Lash First Lic. No.
Engineer's Address Engineer's E-mail Address
city State' Zip Telephone
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CONTRACTOR'S NAME/COMPANYLic. No. Class
Ds �� Sfc oa �5 Lltc, 852 5
Contractor's Address Contractor's E-mail Address
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City wC� YYI ri5 State F Zip - 1�� /% Telephone 7f,(47—o jo
SETBACKS REAR SETBACKS FRONT PERMIT NO. , V •
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. t
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $