HomeMy WebLinkAboutX2016-3859 - Permit Application (2)Print ForWorksheet fo_r Combo Building & Solar Permit Application
Comm'Iesidenti `r ��� q City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
Use F Const Type
# Stories #Units (if Res)
New/Add SFF------! Remodel SFF:�_ ��
OWNER'S NAME Last
Owner's Address
Garage/New/Add
First
Owner's E-mail Address
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(Valuation$
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APPLICANT'S NAME Last
Applicant's
/Address
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ARCHITECT/DESIGNER'S NAME Last
Architect/Designe/es�Add�rejsss y
City State
First
Applicant's E-mail Address
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Zip ,1_(5Telephone
First Lic. No. F&
Architect/Designer's E-mail Address
Zip �j� / l� T e I e p h o n eFq g� ✓3
ENGINEER'S NAME Last First F Lic No.�,
Engineer's Address
............. .... ..... ...... - -- ----- ....
city State w,
CONTRACTOR'S NAME/COMPANY
Contractor's Address J
City—(/Jj'L.�_ — _ State.!
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
Engineer's E-mail Address
Zip Telephoned
No.WS /��Class
Contractor's E-mail Address
Zip �1 Telephone-.__.._w--�c'6.(; ^� 7
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PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $