HomeMy WebLinkAboutX2014-2345 - Permit Application&13-2co1!g
"Punt Form wWorksheet for Combo Building & Solar Permit Application
r Comm" )<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) r Flood KFire r Liq r Landslide rN/A Floor
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Suite No
Description of Work K%klyn c ri '_�;7-hr• f- eiv / n C --3 Use — ConstType � •�
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#Stories # Units (if Resf
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New/Add SF�i�- Remodel SF 15 QG Garage/New/Add_
�—', Material/Labor
OWNER'S NAME Last
Owner's Address
City L�jL_2 State
APPLICANT'S NAME Last
Applicants Address
city I �f Ir-S50 11(2/0 . __ State I / C?
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
CityF _ _ State j
First
Owner's E-mail Address /64' 1 i ) .__)'I I .
Zip
First[_ eon C iSP„_J__
Applicant's E-mail Address
Zip _.0 Telephonely���`r
! First!'. Lic. No.
Architect/Designer's E-mail Address
Zip r Telephone
ENGINEER'S NAME Last First Lic. NoF
Engineer's Address Engineer's E-mail Address
City State F Zip F_ Telephonel�
CONTRACTOR'S NAME/COMPANY `C Lic No. Class'
Contractor's Address
City C. y c ! State �—
✓vr� t I__ I q _
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail AdPd�ress 1
Zip C/_ Telephone F(y�
PERMITNO_
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $