HomeMy WebLinkAboutX2016-2035 - Permit ApplicationPrint Form W
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heet for Combo Building & Solar Permit Application
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City of Newport Beach - Building Division
*� NnTF- PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
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Remodel SF Garage/New/Add
New/Add SF --- -
OWNER'S NAME Last it::�NC �%I�-Qi17 ItIV II 67TMF� First ----------�
Owner's Address Owner's E-mail Address
State
City ---- -
APPLICANT'S NAME Last
Applicant's Address
Use F_ /
ConstType
# Stories # Units (if Res)F
Valuation $
Material/Labor F_
- -
Zip F� Telephone
First
Applicant's E-mail Address
I-
State F_Zip — Telephone__
City --
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ARCHITECT/DESIGNER'S NAME Last S ---_ First Lic. No.
---
Architect/Designer's E-mail Address t
Architect/Designer's Address 5-,5 G MAIL
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City State Zip Telephone
P
ENGINEER'S NAME Last -_
`First Lic. No.
Engineer's Address
5 .Y Engineer's E-mail Address
- - State Zip --
Telephoner®
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City —
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
SETBACKS REAR
SETBACKS LEFT
USE ZONE
Lic. No. I Classl
Contractor's E-mail Address
--
r State � Zip �® Telephone
7SETBACKSFRONTPERMIT NO. Zit `Q -
SCKS RIGHT
PLAN CHECK NO.
DEVELOPMENT NO PLAN CHECK FEES $