HomeMy WebLinkAboutX2017-1409 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division 1?,7q_.2014 5'
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NOTE. PLAN CHECK FEES
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Building .I Grading [Drainage JElec
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Address (Not mailing addre s) lood
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Description of Work
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OWNER'S NAME Last=>TTi�l.f.�
First
Owners Address
Owner's E-mail Address
City (t;UfINt j i'j�i.�l�.( State %'.__J
Zip ,s Telephone
APPLICANT'S NAME Last r(
First _ It
Applicant's Address
Applicant's E-mail Address
City PL15d,J P� State
Zip Telephone
ARCHITECT/DESIGNER'S NAMELastl-ljl+(N,Di=Liss
First Lic, No.
Architect/Designers Address
Arch itect/Designers E-mail Address
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State I�
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ENGINEER'S NAME Last91-1a
First .lti`k'� Lic. No.
_
Engineer's Address �/`L'S
Engineers E-mail Address
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City State
Zip `j`� y(4,, Telephone 7 ]�- 2 S (•� Z�,7'
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J Lic No. �� Class
CONTRACTOR'S NAME/COMPANY
Contractors Address 07cE xlf.Iq -
Contractor's E-mail Address
. City State ,, E-7
Zi i Telephone��',
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK
.^t�O� FEES $
.USE ZONE DEVELOPMENT NO _V/NII9�6"(r/ t PLAN CHECK