HomeMy WebLinkAboutX2016-2168 - Permit ApplicationPrint Form Wor/I�` eet for Combo Building & Solar Permit Applicaati n' 2�
j Comm'I Residential f I City of Newport Beach - Building Division
fff / NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
FtBuilding ❑ Grading 'F-01ainage [ Elec F Mech ❑ Plum Cu Yd Cutl CuYd Fill
Project Address (Not mailing address) ❑ Flood Fire ❑ Liq ❑ Landslide /A Floor suite No
LALCa o �� r 2.,4 Zs
Description of Work
Use E7 ConstType
� o G V'eY # Stories[7 # Units (if Res)F
Valuation $
New/Ad 2 Fj Remodel SFF-- Garage/New/Add Material/Labor
OWNER Last SSe First �Voc
Owners Address
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City Cov'gy,�a AzA m- Statet"
APPLICANT'SNAME Last
Applicant's Address
City C� VA,7� ��1 fir- State
Owners E-mail Address
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Zip ; l2 _5 TelephoneE:--
First
Applicant's E-mail Address
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Zip �I2-�4Z5 Telephone V-13.-n!-D
ARCHITECT/DESIGNER'S NAME Last -First Lic. No.
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Architect/Designers Address
City _ Gcw>T1 State G�
Architect/Designers E-mail Address
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Zip �2�25 Telephone
ENGINEER'S NAME Last �` -V First— Lic No. G80Z33
Engineer's Address
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City ��\�,� _ State �.
Engineers E-mail Address
Zip ck Telephone
CONTRACTOR'S NAME/COMPANY1' Lic. No. o132�Sy Class��-
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Contractors Address Contractors E-mail Address
2-132 �� w �a s b eV1 @�1 �nvr� Co La hlcn7vw
City a. �', State LP Zip Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO. �/ [
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $