HomeMy WebLinkAboutX2018-2228 - Permit Application�EWg
Print Form Worksheet for Combo Building & So ar Permit Application oa
City of Newport Beach - Building Division
r Comm'I r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) r lood [—ILiq J Fire F Landslide [-IN/A Floor Suite No
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Description of Work T!i APP N15 f'/1i 3 fY E4V� /n R36
Usepq�onst Type
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# Stories�I #Units (if Res)F
ZND FW6P- DPl AF � * AP / N 1 i f 9 /�`l
New/Add SF Remodel SF Garage ew/Add
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Mate ial/Labor `
OWNER'S NAME Last ` L 1 First
Owner's Address Owner's E-mail Address
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city �. State Zip Telephone
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APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State— Zip r� Telephoned
ARCHITECT/DESIGNER'S NAME'
Last J� G First I NIMN I Lic. No.
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Arch itect/Designer's Address Architect/Designer's E-mail Address
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City State Zip D TelephoneI/�/ 73e .-.�?P3
ENGINEER'S NAME Last First r4 I Lic. No. CQ�
Engineer's Address Engineer's E-mail Address
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city V^J'' N I State I Zi 7% I Tele hone
CONTRACTOR'S NAME/COMPANY 0�-�5 er/L Lic. No. � `" Class, J
Contractor's Address Contractor's E-mail Address
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City /�� � - - l State 1 Zip % _ Telephone m/`
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SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT _ SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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