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Home My WebLink AboutX2017-1553 - Permit ApplicationPrint Form'' Worksheet for Combo Building &Solar Permit Application o4?`"'M City of Newport Beach - Building Division F Comm" �idential NOTE PI AN CHECK FEES DUE AT TIME OF SUBMITTAL °°T" Mech Plum Cu Yd Cut Cu Yd Fill a g r Ku L/ address rl Flood ( 9 Fire r' 'q i Landslid /A Floor Suite No Prosect Address(Notrnaillin Descriptiionn of Work Use R,3 Q lConstType FF # Stories # Units (if Res)F_1 � Nt VJ Ctl w INM I [ZfAdIFE N, Valuation $ Q Material/LaborFee—I New/Add SF C, Remodel SF , Garage/New/Add OWNER'S NAME Last J Q 5CE- 1 1 First m I KE Owner's Address Owner's E-mail Address / � p J City N'6 _ --.-. _ State _I �fT' Zip 1 2 . U_-_ Telephone APPLICANT'S NAME Last First _ - % Applicant's Address 2( pplicant's E-mail Address __.... city ZiP,, State r—I F—Telephone—_ ARCHITECT/DESIGNER'S NAMELast W� First F� Lic. No. F(2 -7-1 42-r Architect/Designer's Address Architect/Designer's E-mail Address �6� I wCSIG[ I(=(--_�dZ �jWlMaY-Cfi2cTµne.G4T%.,,_ City _.-(V 6 -... - _.State . Zip LbG o Telephone t.+Z—S. Z Z— ENGINEER'S NAME Last JqjAK)544� ( First(=�(L(- j� Lic. No.[Z 3 6 4-0, Engineer's Address Engineer's E-mail Address 1 0� - . ► 'A 0 Q5r ►�� G°+� Zip I "F' Telephone �7j T- �r Z�®© State q 27 CONTRACTOR'S NAME/COMPANY Lic. No. 1sAs� j, Class', YY Contractor's Address bntraciE-mail Address I AAIDT 6p /b city �n4„��trAVW iState Zip Telephone ��I"3��^ �f0 SETBACKS REAR SETBACKS FRONT PERMIT NO. SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $+ ..