HomeMy WebLinkAboutX2018-1578 - Permit Application (2)Print Form` '� Worksheet for Combo Building& Solar Permit Application o��```°"m
City of Newport Beach -Building Division T Q' •
(—; Comm'I �i Residential i'� ? L'19 U
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITAL �<,Fo
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Project Address (Not mailing address) F-1 Flood n Fire r -I Liq f- Landslide (IN/A Floor Suite No
16 C1 anol t I I 6a(AsicU Picea
Description of Work
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Use F7 Const Type
# Stories # Units (if Res)F_1
Valuation $
New/Add SF Remodel SF Garage/New/Add Material/Labor
OWNER'S NAME Last First
Owner's Address Owner's E-mail Address
- -I
City -I State �! Zip Telephone1_____�
APPLICANT'S NAME Last
Applicant's Address
City �— _ State
First
Applicant's E-mail Address
i
Zip Telephone
ARCHITECT/DESIGNER'S NAME Last First
- Lic. No. r'I
Architect/Designer's Address
City �— State
Architect/Designer's E-mail Address
Zip - Telephone
ENGINEER'S NAME Last I First—' Lic. No.—'
Engineer's Address Engineer's E-mail Address
City State Zip Telephone
CONTRACTOR'S NAME/COMPANY „t1���Q Cus�6Rs Lic. No. gG�2�1 Class
Contractor's Address V�
3 5�--vwch 4 }. *44goo
city 2Wpav1 _bJC C.t�, State CA
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
SAU(A;l �f� ('Yt�ili•CGhn
Zip 9z oco p Telephone 149, k'] 3 , 31jt 2 5 -
PERMIT
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $