HomeMy WebLinkAboutX2017-3377 - Permit Applicationx2 I- 23-1
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eet for Combo Building & Solar Permit ApplicationI° ;
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City of Newport Beach - Building Division
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NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL .
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Project Address (Not mailing address) ❑ Flood ❑ Fire E-1 Liq C Landslide ❑N/A Floor Suite No
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Description of Work
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OWNER'S NAME Last
First
Owner's Address
Owner's E-mail Address.
City
'State Zip F- 7_77 Telephoner
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's -.E-mail Address
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`1...
City
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—�
tate
Zip
2�
Telephone �' c/
7� � �-7/�
ARCHITECT/DESIGNER'S NAME
Last First
Lic. No.
`Architect/Designer's Address
ArchitecUDesigner's E-mail Address
City
Stater Zip
f Telephoner
ENGINEER'S NAME Last
First �—� Lic. No.F7
Engineer's Address
Engineer's E-mail Address
City
J State [7_7 Zip
F__ Telephone��
CONTRACTOR'S NAME/COMPANY
Lic. No. 7D g9 J Class
Contractor's Address
Contractor's E-mail Address
CiState
ty Q art--�-C•t{—�
�� Zi Tele hone
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SETBACKS REAR
SETBACKS FRONT.. PERMIT NO.
SETBACKS LEFT la
SETBACKS RIGHT 6 PLAN CHECK NO.
USE ZONE
DEVELOPMENT No PLAN CHECK FEES $