HomeMy WebLinkAboutX2017-2165 - Permit Application%comm'I r Residential
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Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division ! ' -f(a, 5. Dr.
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL ---
(Building [ Grading [TDrainage I— Elec fi Mech f- Plum cued Cut
Project Address (Not mailing address) FT Flood j Fire FT Liq fi Landslide
CuYdFill
EN/A Floor
Suite No
I c 14 6- ._Pptr
Description of Work
Use
i ConstType
/Nr4-G-C4i7ohF OF E Lt c- f2rcWW1C Le CC9"V / >---
# Stories'
# Units (if Res)j
Valuation $.
New/Add SF'
Remodel
SFf
' Garage/New/Add
Material/Labor]
OWNER'S NAME Last
Owner's Address
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Ow
-Firs/
ers E-mail
Address
City' State i -.. Zip I Telephone'
APPLICANT'S NAME Last
Applicant's Address
I First!
Applicant's E-mail Address
1126 SSt PA-(- - VC
a A/.-T2AnreVVOCortF-t,OVCT
City jSA4t-t?,T1 aRE"A _.. ,, State
� - Zip`72,-b
cif Telephone[462 S72-C6? 3
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
First Lic. No.
Architect/Designers E-mail Address
City ( -. State
Zip
Telephoned
--.._..
ENGINEER'S NAME Last' First i Lic. No.'
Engineer's Address Engineers E-mail Address
City i State i I Zip 1 Telephone'
CONTRACTOR'S NAME/COMPANY
Contractor's Address
Viow Ydet% '?sr1 COHY(uNrct77cc/s Lic. No. f 2 (C9 Class; CO
Contractors E-mail Address
1 2C, 2,5 PP, LA D\2_ 1 Jvb N1a-�fl yL4E- / VvDcaf-a M. rve!
City
16p-yLr -Curt tk= -_-_ State [dA----- Zip192-`-cl TelephonehI`(-Sti1'-
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SETBACKS REAR SETBACKS FRONT PERMIT NO. 'v v l / — ?IC")
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $