HomeMy WebLinkAboutX2017-2093 - Permit Application (2)I,P6'5-2o►-7
x101 -7-90R3
Worksheet for Combo Building & Solar Permit Application
F_ Comm'I ri Residential City of Newport Beach - Building Division
NOTE: PLAN rHFCK FFF3 nuF AT TIME OF SUBMITTAL
F -Building F Grading F -Drainage F_Elec F-Mech
F- Plum Cu Yd cutF Cu Yd Fill F
N/A�
Flood Fire Li Landslide � Floor Suite No
Project Address (Not mailing address) F_ � r
� �
S:_0 net N� pvrd CQAt,f Ct1" 1 Z�S
Description of Work
Use Const Type
# Stories #Units (if Res)
P&141
I&I11ti
Valuation $
New/Add SFF— Remodel SF o %J Gara a/New/Add
I Z g F—
Material/Labor'
OWNER'S NAME Last�� • r a ,, /L
First O(L
Owner's Address
Owner's E-mail Address
n�
6 SrO,r�lZ� !s/�j
City rJe--Pcloil J_ State CA
Zip. 2,(<i54- TelephoneF 6L'�t�3^��'�►b3
APPLICANT'S NAME Last 4r First l c�A (,G)
Applicant's Address
Applicant's E-mail Address
City �;..i C ;'ti`.�✓� S State IC.A
Zip G' 2_:?Z�'. Telephone eO � 01
ARCHITECT/DESIGNER'S NAME Last I �e /�
First Lic. No. C Z Z 110 2-
Architect/Designers Address
ArchitecUDe E-mail Address
c
isigners
City C' o i r A- 1 ' -s,'`T State cA-
Zip CC 7i�Telephone. / Yj- 1 'S '. of L. J
ENGINEER'S NAME Last �v P f�
First >H!{ S Lic. No. sj J 73 aT
Engineer's Address
Engineer's E-mail Address
lSt i/�GM�S ®��05 i'►�o T�M�1qu,;�����ate >Gq
City C�.J,j r}'�-. fri'LS - _. _ State G _
Zip � 2(,'-2... Telephone[G 7 0-1)00
CONTRACTOR'S NAME/COMPANY J;oAn-AV4IU
Lic.No. QJ IZc1 Class
Contractor's Address
Contractor's E-mail Address
City �;.1L.,+ A) }'� S State �/} --
o 2 v Telephone uS C d
Zip C r 2
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $