HomeMy WebLinkAbout1062-2017Worksheet for Combo Building & SolagfM5W �bl\n jP1
_ _ City of Newport Beach - Building Divissiio�nTV,f]�
Comm9 Residential r.inTG of 4N rNFC.K FFFS DUE AT TIME OF 3CR3MI I YAL NEWPORT B�J�1
r'Building Grading ;-Drainage v', Elec ;r Mech
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Project Address (Not mailing address) Flood
i- Fire i- Liq -Landslide ! N/A, Flo or Sdit�e No
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Description of Work
Use i ConstType'
Re-etcice ext5\R �tre.ss__ e.� rO��e -
Sa.rnP LOGG.±ton
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#Stories; tkUnits(ifRes)r
ieptace Ater - Sterne ipo�RY\�
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Valuation $
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New/Add SFRemodel SFi X
Material/Labor'! r
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OWNER'S NAME Last Ny-on
First] �oc.(.i.{ .ict-`\e-
Owner's Address
Owner's E-mail Address
333 S. Stci�e sitee� SLLAe J-Ilta
CityL�K� �54}ec3o State p(�
Ziplct�p Telephone' $0&-f`��to
APPLICANTS NAME Last
First
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Applicant's Address
Applicants E-mail Address
1
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city ! State �'i
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Zip Telephone;.
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designers Address
Architect/Designers E-mail Address
City State
Zip Telephones
ENGINEER'S NAME Last-,,_-Prir-5
First� MC_SnL A Lic.No.'S3glo1-
Engineers Address
Engineer's E-mail Address
a3 Drchnrcl Faso
m�:,l��5a-se.�or*.
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CRY !_eke. �oreS� State C(�
Zip 9ai_30 Telephone g413j 214o-4gAq
LicNo.15,6,1434 Class.(��$
CONTRACTOR'S NAME/COMPANY Shel(rnc�.4Ge.r
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Contractors Address
Contractors E-mail Address
93'T LJ- 117_t Sty eel
54 ellmo 15�s C' sbcct�ob��• n��
City [0StG fyle.5c. State I cfi
zip g31a.Ll Telephone q ff S, g S3S`1
SETBACKS REAR
SETBACKS FROiN_
SETBACKS LEFT SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
STRUCTURAL GENERAL NOTES
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CITY OF NEWPORT BEACH
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W'LLIAM SIMP'ON
6 ASL IATSB, INC.
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p7 HAREM p3ulp ROAD
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Mr. S Mrs. Rocky 8 Julio Dixon
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CoufYtnac fAYOVr"l 1.01.11.t
NEWPORT
BEACH,
CA 99600
333 S. Stab Str""t, Suva
V-118
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Leka OYo9o, OR 97034
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