HomeMy WebLinkAboutX2016-1812 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o<��°°' m
�Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL '`'��>�"
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Project Address (Not mailing address) C Flood r Fire r Liq r Landslide
Description of Work "ARA i YA Tffm C
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Material/La or
New/Add SFF — Remodel SF��(_ ' Garage/New/Add —'
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OWNER'S NAME Last C ✓r� Cwp�s� first
Owner's Address Owner's E-mail Address
city Qj State �� Zip I ` V Telephone
APPLICANT'S NAME Last �•,�;� First lCt�17L-Lr_..-.
Applicant's Address Applicant's E-mail Address
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City I I—d 1:11�;-�. �� C_..� State (' Zip mil �i"I:'� Telephone 1, 4 9) �0�17 "oJ�(
ARCHITECT/DESIGNER'S NAME Last j� First C4 IA5Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City �.-� V7�!T fj.0 }� State G�. Zip 92 Telephone (c 4 ct) <J'75
ENGINEER'S NAME Last )-L-CHT First r7,AoU( Lic.No.
Eng(iinneer's Address Engineer's E-mail Address
City StateZip (il'%(p�Qj _. Telephone�J
CONTRACTOR'S NAME/COMPANY nYV\ �OY{r �V�(J[ IUV� Lic.No. -tLq(yC�3 Class
Contractor's Address Contractor's E-mail Address
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City Ir' cAlir4rj 781n19't State 7 Zip C j2-JV5 Telephone -71''1-51{S- I;GS�
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. _ }• yl 5
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ _ n1T� .2�j�
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