HomeMy WebLinkAboutX2016-3706 - Permit Application�EWCp
Print Form Worksheet for Combo Building & Solar Permit Ap lic I of f a
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F_ Comm] Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) r7 Flood
r Fire 7 Liq F_ Landslide <N A Floor Suite No
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Description of Work
Use [7 ConstType
# StoriesT #Units (if Res)
IYEW
d%il�T e 2�rg�
New/Add SFr__ Remodel SF�^ Garage/New/Add F_
Valuation $
Material/Labor �af
OWNER'S NAME Last
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First i•,rR1�2c._
Owners Address
Owners E-mail Address
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State @g
Zip — Telephone 9y 3�56 i
APPLICANT'S NAME Last LCmTu
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Applicant's Address
Applicant's E-mail
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'Address
City _ Il S
State 07_ � li
Zip 7— Telephone 5 z(b „��
AREHFFECT/necrrNER!c nr ,e�ea
Last �„ _�,� _
First /t'l'9l(50 Lic. No. F_
Architect/Designers Address
Arch itect/Designers E-mail Address
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City Crjj,ya
�ii State �. �--_
Zip F_ Telephone Z•�1�
ENGINEER'S NAME Last
First Lic No.F
Engineer's Address
Engineers E-mail Address
City
State
Zip F Telephoned
CONTRACTOR'S NAME/COMPANY
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Lic.No. FWlm ClassF
Contractors Address
Contractors E-mail Address
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Zip Telephone
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SETBACKS REAR
SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $
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