HomeMy WebLinkAboutX2015-2863 - Permit ApplicationL.Print Form Worksheet for Combo Building & Solar Permit Application?`" a
omm'I r Residential City of Newport Beach - Building Division o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 5.".e.••'
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Project Address (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work Use st Type
# Storiee # Units (if Res)
New/Add SF�— Remodel SF�— Garage/New/Add
"aluation
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OWNER'S NAME Last
Owner's Address
City `✓ Vo t�-y� - State
NAME Last I P
Applicant's Address
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City `Irl,/r vL� State
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Owner's E-mail Address
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First) `/�(OVl✓i�
ant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last I BuE�i t I a
Architect/Designer's Address Arch
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City V- "A t,.• State C
First Lic. No.�
'Designer's E-mail Address
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ENGINEER'S NAME Last 10 ( First s-- Lic.
Engineer's Address
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City FF—c; �rl `i�State Com. I
Engineer's E-mail Address
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Zip .OtZr,Q".�Q Telephone[Q "l,ry'rt ,�I J,(p .51aoo
CONTRACTOR'S NAME/COMPANY �/ �p % Motrrt �p� �� Lic. No. ASI944Aass�''
Contractor's Address Contractor's E-mail Address
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City 1 State Ca Zip:i? ( I; Telephone
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SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
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