HomeMy WebLinkAboutX2018-3715 - Permit Application (2)Zee z- 2ot 0 -X2a18 3 15
Print Form'..; Worksheet for Combo Building & Solar Permit Application
❑ Comm'I kResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building ❑Grading ❑Drainage ❑Elec ❑Meth ❑Plum cuvdCut I cuvdFill u
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
Description of Work
AVD _ �+r
New/Add SF Remodel S� j�Garage/New/Add
OWNER'S NAME Last
Owner's Address
First i i",
Owner's E-mail Address
Use F-iTe-7 Const Type
# Stories[T # Units (if Res)[7
Valuation $
106®x.
Material/Labor
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city � t„(�� �('- 13C � State Com+ Zip vp� g TelephoneF ------------ 7
APPLICANT'S NAME Last, -tom-- First Iy F hh
Applicant's Address Applicant's E-mail Address
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City I -T-U5,T A I Statet✓/'-i Zip (A2j bi) Telephone (J r q5 9 8c-}-7
ARCHITECT/DESIGNER'S NAME Last
(�;,f rz� Lt First Lic. No.
Architect/Designer's Address - Architect/Designer's E-mail Address
I
City State 777 Zip Telephoned
ENGINEER'S NAME Last N.N/— I M First FY Lic. No. i UNC
Engineer's Address Engineer's E-mail Address
I I
City I State Zip Telephoned
CONTRACTOR'S NAME/COMPANY OIJ Lic. No. 3:? Class
1 11
Contractor's Address Contractor's E-mail Address
City ��, _ J State t�JQ j Zip 2zq�Telephone 3
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. i
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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