HomeMy WebLinkAboutX2018-2868 - Permit Application'G6l96900"',
Print Form
Worksheet for Combo Building & Solar Permit pplication
Comm 'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[Building ❑Grading ❑Drainage F7Elec ech Plum Cu Yd Cut' Cu YdFill
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Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq kindslide ❑N/A Floor Suite No
Description of Work
J g Use � Const Type
p
/ — 0 # StoriesT # Units (if Res)[T�
Remodel SF t Gara a/New/Add Valuation $
New/Add SF 2[ ( -_/.iGUI g Material/Labor
OWNER'S NAME Last
Owner's Address Owner's E-mail Address J+�
city
--. _------_...--- ----I State _—..� ZIP TelephoneF�
APPLICANT'S NAME Last+V_l�
-�- � First.---
ApplicCantt's Address Applliaicant's E-mail Addre�s
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51 V – – Zip Hty(.(LZL.
City � p,A)e_�1,.--. cf/i,_U,r✓. State _ C, _ - _� P "I Z!t!G �p e 'f�4 %�: Z.i . � r✓n
AMILHITEC 'UET[ -__./ SIClNER'S�I,tAME Lastl _I First
\Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
CrtY FI �. State I Zip F'-- TelephgneL.
J
ENGINEER'S NAME Last ( ���"'y✓t +. I Firsts Lic.
- - - - - - ru 1
Engineer's Address Engineer's E-mail Address
City
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
SETBACKS REAR
SETBACKS LEFT
USE ZONE
State I Zip I J Tale phone I
Lic. No.F _7 Class
Contractor's E-mail Address
I
State Zip �Telephone[
SETBACKS FRONT PERMIT NO.
SETBACKS RIGHT
DEVELOPMENT NO
PLAN CHECK NO.
PLAN CHECK FEES $