HomeMy WebLinkAboutX2013-1364 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
Comm'I Residential NOTE: PLAN CHECKFEES DUE AT TIME OF SUBMITTAL
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Mech Plum cu rd cut Cu vd FillK.B
Flood ri, Fire rl Llq r Landslide N/A Floor Suite No
ress (Not mailing address) r-
-
Q Use
- Const Type
Description of Work
# iStoriesZ; # Units (if Res)�I � t
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Valuation5
� RemodelSF Garage/New/Add r, Material/Labor
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M/ e d F � � ' -
{ First 1.ol
OWNER'S NAME Last j(�{-ITUPI-_
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owner's Address Owner's E-mail Address
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OV�GL� cam_
cityi"�_�t;'/.''�T1___�. State Zip 2(3 Telephone
APPLICANT'S NAME Last ��" � First
--- -
Applicants E-mailAddress
Applicant's Address ;
State C ZiprC Tel
City _. ..
ARCHITECT/DESIGNER'S NAME Last 1 First—j Lic.
Architect/Designer's E-mail Address
Architect/Designer's Address
FState Zip Telephone
City __.._ ..
�I Lic No
_First ,,-...__-
ENGINEER'SNAME Last
Engineer's E-mail Address
Engineer's Address
State �— Zip Telephone _
City .__. .. .-
-- Lic No Class
CONTRACTORS NAME/COMPANY
Contractor's E-mail Address Contractor's Address_,___�—
State ZIP, Telephone�—
City
r SETBACKS FRONT—__ PERMIT NO.
SETBACKS REAR
PLAN CHECK NO.
U
SETBACKS LEFT SETBACKS RIGHT
USEZONE--
PLAN CHECK FEES $ —
DEVELOPMENT NO.