HomeMy WebLinkAboutX2018-1754 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o PC
F comm"I/ Residential City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading [-Drainage jMiec lf�?[vlech
NPIum CuvdCut F CuvdFill F
Project Address (Not mailing address) FI Flood F Fire rI Liq rl Landslide CIN/A Floor Suite No
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Description of Work
Type Use ConsiT e
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#Stories #Units (if Res) F—I
Valuation $4 /�
Material/Labor � � N0
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New/Add SF I 1 Remodel SFF— Garage/New/Add I -
OWNER'S NAME Last First [)o
Owner's Address '
Owner's E-mail Address
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City L �
N� (-+ Ua State I �I r it
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Zips _`�` Telephone
APPLICANT'S NAME Last �(,11'i�
First t
Applicant's Address
Applicant's E-mail Address
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City �5,1 (� t nS �A� State —�I
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Zip _ � �J' Telephone
ARCHITECiT. E/D SIGNER'S NAME" Last ., First M Lic. No.
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
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mrn�desi hag maf , r�(Y�
City it Stin 1 n.S\ `v� State —III
Zip g �f Telephone q t L{-.�ji ( E-! -90-(b
ENGINEER'S NAME Last I -aXYI
First e l (� Lic�No.l-�
Engineer's Address
Engineer's E-mail Address
TO s0—o 3 L
City G 0JQ6Lt1 V y "� State ��,
Zip I ��'!.� ! Telephone _. (� J �a�S
CONTRACTOR'S NAME/COMPAN �n sfT (C-'-� O ic. No�.
Contractor's Address
Contractor's E-ma I`Ad�dress
_
City U e 1 1 / 1 lYl S'� State
Zip hone _'
SETBACKS REAR SETBACKS FRONT + O PERMIT NO. XVI GV 11 •`(��J
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. MJ ZDI�ZD17
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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