HomeMy WebLinkAboutX2018-2957 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
[- comm'IResidential City of Newport Beach - Building Division (�
'NOTE; PLAN CHECK FEES DUE AT TIME OF SUBMITTAL "(
Building j Grading F ainage Pei j�"Mech `/malum Cu Yd —71 cuvdriu
Project Address (Not mailing address) CI Flood [ j Fire C Liq _ ndslide ❑N/A Floor Suite No
Description of Work
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New/Add SF 1, If, l Remodel SF1J
OWNER'S N E Last r %'1C It
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Garage/New/Add
First I. ,a
Use F Const Type L
# StoriesF # Units (if Res)F
M ' SaM
Owner's Address Owner's E-mail Address
City -,_ State �— zip F____7 TelephoneF-1
APPLICANT'S NAME Last First J
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Applicant's Address Applicant's E-mail Address
F
City I ----._ - . State Zip Telephone
ARCHITECT/DESIGNER'S NAME a
Last ;First t Lic. No
Architect/Designer's Address Architect/Designer's E-mail Address
city.r'`— - _--_ State.—_�I Zip UL j _ Telephone
ENGINEER'S NAME Last First - Lic. No [�� ?
Engineer's Address Engineer's E-mail Address
17--Z312
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CityLv State �� Zi7`)'' -__ . Telephone _h
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CONTRACTOR'S NAMElCOMPANY p /�y(� �qJ % U �C �- Lic. No.°( I ( Class
Contractor's Address Contractor's E-mail Address
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City I State �,!/� Zip Telephone 'P'C f ���///�� ,� 2_6 3
SETBACKS REAR
SETBACKS LEFT
ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO,
PLAN CHECK NO.
PLAN CHECK FEES