HomeMy WebLinkAboutS2018-0125 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
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City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTA
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Project Address ( ailing address) F Flood F-i Fire r, Liq f—, Landslide nN/A Floor Suite No
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Description of Work Zj -
Use F II--� Const Type
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IF Stories # Units (if Res)
V luation $
M terial/Labor
New/Add SFF iii F ' Garage/New/A
Remodel SF dd �y� �� (r
OWNER'S NAME Last �c ' [ (. S First
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Owner's Address
1.10 Owner's E-mail Address
city State F ZiP / L� /-✓ TelephoneF—
APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
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City )5c Wf'?vr• t- t5c'GZ,i.�., State CG.r.. Zip (.P Z/.. Telephone 7t'y % %S' liry JLI
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ARCHITECT/DESIGNER'S NAME Last First •'., Lic. No. �---
Architect/Designer's Address Architect/Designer's E-mail Address
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City State �—i, Zip �Telephone[—
ENGINEER'S NAME Last E-Zc, L` ;�. �. First �] 3 T-150 Lic No.�—
Engineer's Address Engineer's E-mail Address
City
State Zip �—'. Telephone—
CONTRACTOR'S NAME/COMPANY 'sC . Lic. No. /`7�"y-7cJ Class ''� �'
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Contractor's Address Contractor') E-mail Address i
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City / V , State C 'F ZIP ��2�,., j� j%� Telephone I�
SETBACKS REAR �_ SETBACKS FRONT 2U PERMIT NO. SZO 1'�C `]
SETBACKS LEFT Lv SETBACKS RIGHT (y PLAN CHECK NO.
USE ZONE 'r— — I ^ DEVELOPMENT NO PLAN CHECK FEES $