HomeMy WebLinkAboutX2018-2348 - Permit Application (3)Print Form Worksheet for Combo Building & Solar Permit Application
Comm'I F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (N
ot t mailing address)
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(- Flood Fire ��iq F_ Landslide F N/A Floor
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New/Add SF� Remodel SF Garage/New/Add
OWNER'S NAME Last .. WO IS First
Suite N
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Use I tf) Const Type vf 3
# Storiesi # Units (if Res)[_
Valuation 11
Material/Labor
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Owner's Address Owner's E-mail Address
City�..� State �-1
Zip Telephone
APPLICANT'S NAME Last V x� V 1 - �` First
Applicant's Address j Applicant's
E�-mail Address
City _ State F f '/A Zip 612SV Telephone •203 ;, t-j-
ARCHITECT/DESIGNER'S NAME Last D �gu�z First V Lic. No. CC MC
Architect/Designer's Address Architect/Designer's E-mail Address
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City State Zip Telephoned 2 J (3tY t
ENGINEER'S NAME Last 1 Vh Ua-_ First ._��� �.1.1. ...... Lic. No. 2 5 iDt
Engineer's Address Engineer's E-mail Address
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City {'� State F Zip Telephone �� '22-1 261
CONTRACTOR'S NAME/COMPANY j Lic. No. US_s57 Class
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Contractor's Address Contractor's E-mail Address
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City n �.('] _.. State Zip "1�� Telephone
SETBACKS REAR _ SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.—P,
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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