HomeMy WebLinkAboutX2018-3257 - Permit ApplicationXaug ash
Print Form Worksheet for Combo Building & Solar Permit Application a9iPo"'e
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City of Newport Beach - Building Division ' Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL V
I -'.Building F. Grading Drainage F-,Elec r"iMech F-1Plum cuYdCut I� cuvdFill F
Project Address (Not mailing address) Fi Flood FI Fire ri Liq F- Landslide FN/A Floor Suite No
Description of Work
Use — ConstType l
# StoriesF—1 # Units (if Res)n
Valuation $
Material/Labor
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New/Add SF Remodel SF I Gara a/New/Add
OWNER'S NAME Lastf �'..!/1'AJAI_TR_I I First I M' )jI, t.-1% D...
Owner's Address Owner's E-mail Address
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City[ ; _'.. • ' :/R� T :' 6, �� ; 'I, State " /�
I Zip � („5 Telephone
APPLICANT'S NAME ..
Last "�; t. t-t �i First _-16p�t-nL -
Applicant's Address Applicant's E-mail Address
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City _ r�;_�. i State �— Zip T-5ots I Telephone v �i;j�-7947�
ARCHITECT/DESIGNER'S NAME Last �"- First-' Lic C�Architect/Designer's
Address (�,SiZ_,Q Architect/Designer's E-mail Address �.J
City State F Zip F, Telephone
ENGINEER'S NAME Last First—! Lic. No.�
Engineer's Address Engineer's E-mail Address
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City Stateli Zip —.I Telephone�I
CONTRACTOR'S NAME/COMPANY i l , j �v`i Lic. No. 76Uj�' Class
Contractor's Address Contractor's E-mail Address
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City ,_ "i-. ;` '�, -. 4_ —,,.., State ��� Zip U�.�' Telephone c
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $