HomeMy WebLinkAboutX2018-0916 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit A pllc�tio � _a
r Comm'I r Residential City of Newport Beach - Building Division I SkA& ftI
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 44"W"
(X Building r Grading f --Drainage r Elec r MechPlum
r Cu Yd Cutndsllde Cu Yd Fill 1.6r, IMP
Project Address (Not mailing address) I- Flood r Fire r Liq af`N/A Floor Suite No
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Description of Work
j Af-k Kvi-nom, Use Const Type IU-
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# Stories # Units (if Res)f—
New/Add SF N rk Remodel SF ��-- — r--+ Valuation $
I /✓(/r Garage/New/Add I f,,'/F Material/Labor
OWNER'S NAME ,�,,,, —
Last I,�kS First �n .
Owner's Address 1"`
Z Owner's E-mail Address
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City rh f .0 � (1�M o� State CA 2 r/
�/ Zip TelephoneF
APPLICANT'S NAME Last Richart 7 U
First liason
Applicant's Address
1041 W. 18th St, (A106) Applicant's E-mail Address
Jason(ghchartdesign. net
City lCosta Mesa State CA
Zip 92627 Telephone 949-422-9191
ARCHITECT/DESIGNER'S NAME
Last Richart First Jason
Architect/Designer's Address Lic. No.
Architect/Designer's E-mail Address
1041 W. 18th St, (A106) Jason@richartdesign.net
City Costa Mesa StateCA Zi 92627
P Telephone 949-422-9191
ENGINEER'S NAME Last WANKET _—`
FirstNEAL Lic. No. i" -" --
Engineer's Address ` g /J
Engineer'sE-mail Address I/
City StateA
— Zip r—` Telephoner I�
CONTRACTOR'S NAME/COMPANY
vi Lic. No. �C�/53-0 ClassFT
�'ontractors Address
Contractor's E-mail ` Address
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��1l3rai/R/�2f1!�i� Ez�o 3� �7` j
1 t StateF7R, Zip �I�Zor Telephone f p _
REAR SETBACKS FRONT �f
PERMIT NO. �_
LEFT SETBACKS RIGHT
DEVELOPMENT NO PLAN CHECK FEES $