HomeMy WebLinkAboutX2017-3478 - Permit Applicationn-v �%� - 3 N g
Wo/pkshe t for Combo Building & Solar Permit Application 009
Comm'l Residential 1 xCity of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood F_ Fire [_ Liq F- Landslide /A Floor Suite No
Description of Work
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Valuation FF5;0e1_00
Material/Labor
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OWNER'S NAME Last 1 f—r—_. - r First
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Owner's Address 1^✓
Owners E-mail Address ✓
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City State 4 k Zip 2 TelephoneFJj4724 ZNV,0
APPLICANT'S NAME Last 1 M WFirst
Applicant's Address Applicant's E-mail Address
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ARCHITECT/DESIGNER'S NAME
Last � First F Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
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City State F_- Zip F— Telephone-- 12 I (C G
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ENGINEER'S NAME Last I First Lic. No.
Engineer's Address Engineer's E-mail Address
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City F State F_ Zip �— Telephone
CONTRACTOR'S NAME/COMPANY 1 �'�_ S a Sr(--� Lic No.
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o/ntractors Ad�drress Contractors E-mail Address
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City L� `r' G�L, /V/L State Zip r� L-�/ Telephone
SETBACKS REAR SETBACKS FRONT 5 PERMI
SETBACKS LEFT 5 SETBACKS RIGHT � N CHECK NO.
USE ZONE _ DEVELOPMENT N " PLAN CHECK FEES $
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