HomeMy WebLinkAboutX2016-2014 - Permit Application�4W�ar
Print Form Worksheet for Combo Building &Solar Permit Application
City of Newport Beach - Building Division
F_ Comm'I r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r-Building F_ Grading f-Drainage I-Bec Mech r Plum CuYdCut CuYdFill s
Project Address (Not mailing address) F_ Flood F_ Fire Liq F_ Landslide [N/A Floor Suite No
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Description of Work
Use s ConstType F
&PL-R t I-il -r -SSM eJPE5 L�AI_le1 ftq 1-fr�
#Stories # Units (if Res)F_
Valuation $
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New/AddSFF Remodel SF Garage/New/Add
Material/LaborF7,;LDQ.®D
OWNER'S NAME Last LIOo I5 1?4>^ M 0,0t clI1!5-D:fust
Owner's Address Owner's E-mail Address
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City-�QJP�R-T--.Oc.R�FI _ State - -. CH_-__ Zip q% j_/o3 Telephone 54 f 6'73'laf1dn
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City State F— Zip F Telephones
ARCHITECT/DESIGNER'S NAME Last First �— Lic. No.
Architect/Designer's Address Arch itect/Designer's E-mail Address
City State Zip �— Telephoned
ENGINEER'S NAME Last (�)r_.Ll R✓rl S'ihIPSArY fi55 St 5 Lic No.5391 oti _
Engineer's Address Engineer's E-mail Address
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City LHKE Fop-E5� State c �-}' - Zip-Cj'a�3a- - Telephone y<J� aov- 49a
CONTRACTOR'S NAME/COMPANY E2 I�G. Lic. No. a)r}3 � Class
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Contractor's Address Contractor's E-mail Address
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City I Gj, mce R State FC—A Zip caL-27 Telephone F45 s-q
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $