HomeMy WebLinkAboutX2017-0082 - Permit ApplicationPrint Form W et for Combo Building & Solar Permit Applica ' n o�a�W�Rf
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City of Newport Beach -Building Division A� � I - V V
Comm'I Residential
� NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ,a
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Project Address (Not mailing address) F_ Flood
F- Fire C Landslide [N/A Floor Suite No
Description of Work
Use 5� Const Type F
# StorieslF:Z # Units (if Re.-)F
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e /Add SF Remodel SF
Garage
� Valuation $
�lew/ dd Material/Labor �J
OWNER'S NAME Last
First O j
Owner's Address r
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Owner's E-mail Address '" 0/Z,
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City ��
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State J;
Zip �� _�_�_ Telephone q �{
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APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
1
City , F-,)-- -
State Zip % TelephoneLVOV
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ARCHITECT/DESIGNER'S NAME Last
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First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
i
City
State �—
Zip Telephone
ENGINEER'S NAME Last
o
First Lic. No.
Engineer's Address
Engineer's E-mail Address
7
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City L
State
Zip Z % Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. �— Class
Contractor's Address
Contractor's E-mail Address
City
State �—
Zip Ls Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $