HomeMy WebLinkAboutX2016-2512 - Permit ApplicationI Print Form ' ��worKsneet for compo Building & Solar Permit Application oF��� "";
(- Comm'I �ResidentfaY ��I '2� 0 City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL oa '
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Project Address (Not mailing address) F_ Flood F- Fire r Liq r Landslide r -N/A Floor Suite No
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Description of Work
Use F Const Type 7
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# Stories # nit
Valuation $
Material/Labo
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New/Add SFF_RemodelSF7 Garage/New/AddF-
OWNER'S NAME Last I �\02Zef First
Owner's Address Owner's E-mail Address
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APPLICANT'S NAME Last -BLAVZFirst I cyVL%�M:'14011-
Applicant's Address Applicant's E-mail Address
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city �n5St9 �A State �, Zip 2�OZ4 Telephone (�-, 404
j ARCHITECT/DESIGNER'S NAME LastdvJ First I P 31(P3'
J� (.,,STD kl.tst - Lic. No.
Architect/Designer's Address Architect/Designees E-mail Address
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ENGINEER'S NAME Last I 1UA-.tS;it-tD1 First FP�NAri> Lic. No. C. 3,r %4c)
Engineer's Address Engineer's E-mail Address
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City State �Tt Zip q2_7+01 Telephone _'H q.$2,,S7. ?_b60
CONTRACTOR'S NAME/COMPANY ?pM,, Sera �lUsrpyyv )�p/y�t3 Lic. No. 0071"J�"� Class
Contractor's Address Contractor's E-mail Address
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MCW?B,U '&C -P Ck State Zip ZIADa Telephone q -A -2Z, 10400
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES