HomeMy WebLinkAboutX2017-1822 - Permit Application (3)40 7v r
PrintT.orm Wo
for Combo Building & Solar Permit Application
Comm I ❑ResidentialCity of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building F.7 Grading []Drainage ❑Elec ❑Mech ❑ Plum cuvdcut� cuvdFiuF
of
New/Add SF
address) ❑ Flood ❑
Landslide ❑N/A Floor Suite No
F7
Remodel SF Garage/New/Add
OWNER'S NAME Last
Owner's Address
First
Owner's E-mail Address
Use F71 Const Type
#3Car�es� # Units (if Res)E]
ab). I61UW
City State Zip F77:77] Telephoned
APPLICANT'S NAME Last I I First I 1
Applicant's Addre:;s `
City State
Applicant's E-mail Address
Zip Telephoned
ARCHITECT/DESIGNER'S NAME Last First
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
------------
City State Zip Telephone
ENGINEER'S NAME Last First Lic. No.F7777
Engineer's Address
City State
Engineer's E-mail Address
Zip F77771 Telephone
CONTRACTOR'S NAME/COMPANY -retZ2,4 3�CCt+ ��tJ_ Lic. No. $Q7 -, Class
Contractor's Address
City /SS /� _ 1/<�� StateZA
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
Contractor's E-mail Address
Zip Telephone g) q/4 OY7
PERMIT NO.
PLAN CHECK Nd.12 ,7e)
PLAN CHECK FEES $