HomeMy WebLinkAboutX2013-2927 - Permit Application�D ,
Print Form Warksheet for Combo Building & Solar Permit Application,:
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r comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN. CHECK FEES DUE AT TIME OF SUBMITTAL
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IXBuilding Grading ['Drainage iec J ch > PIVm cuYdcutI CeYdFill
Project Address (Not
)escription of Work
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w/ dd SF
licie Floor _alrF No
Use I ' `/ Const Type I V i?
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# Stories # Units (if Res)T
Valuation $
Garage/New/Add ( Material/La
OWNER'S NAME Last I --Fa V a t _; / First c3e S �
Owner's Address CP V I a cy,,NsYa do Owner's E-mail Address 4�,
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City ��� Cor,�5+ State C' A Zip Telephone
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APPLICANT'S NAME Last
Applicant's Address `71
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City N'^' p r+ C oaii* State I CA .
AREHITECT/DESIGNER'S NAME Last / cj 1/1 (1
Architect/Designees Address
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First F�nA +�eiboc Cl(�
Applicant's E-mail Address
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Zip I Telephone
First 17 it vjy\ Lic. No. —
Architect/Designer's E-mail Address
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Zip Telephone ` q q ZZ tl� '7 13 CJ
ENGINEER'S NAME Last /�� /F � ,1,�
Jr^ First Lic.No.l 77ot '
Engineer's Address^ Engineer's E-mail Address
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City paYt a �� f State 1 6 _ Zip Cz�,�l1f Telephone�� •�I�.�
CONTRACTOR'S NAME/COMPANY Lic. No. I Class
Contractor's Address
City I State (_.
SE iBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
Zip
Contractor's E-mail Address
TelephoneF—
PERMIT NO.
PLAN CHECK No. S
PLAN CHECK FEES $
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