HomeMy WebLinkAboutX2016-2087 - Permit Application13R`7-2016 V0I6-.2087
Print Form Worksheet for Combo Building & Solar Permit Application ou r' Comm'I ( ResidentialCity of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) [-I Flood r Fire [- Liq [- Landslide [-N/A Floor Suite No
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OWNER'S NAMEp�
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Owner's Address
Owner's E-mail Address
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Zip ��; Telephone
APPLICANT'S NAME Last rU` t/__...
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Applicant's Address
Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME Last
_ First Lic. No.j
Architect/Designer's Address
Architect/Designer's E-mail Address
City _ State �.
Zip I Telephoned
ENGINEER'S NAME Last
First F Lic N 3
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Engineer's Address
Engineer's E-mail Address
City _ State
Zip F Telephoned—
CONTRACTOR'S NAME/COMPANY Zi 'Y, �uCGI Lic. No. I7!' ClasscG-Z
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Contractor's Address
Contractors E-mail Address
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO. 1/U
'F�
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $