HomeMy WebLinkAboutX2017-1441 - Permit Application (2)r
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Worksheet for Combo Building & Solar Permit Application
1- Comm'C Residential City of Newport Beach - Building Division a
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
`Building r- Grading [-Drainage, F-Elec F-Meth. r-Plum cuedcutF cu Yd Fill
Projeet Address (Not mailing address) f- Flood r Fire" F- Liq r Landslide 1-N/A ' Floor Suite No
2.�2o s+ �,/ G m Gla
Descrnptlon 6f Woirk se eronstT e
C #5toriebI # Units (if Res)
` Valuation$
New/AddSFF 'Remodel SFF— Garage/New/Add �� Material/Labor' .
OWNERS NAME Last First I`G{kcL-e-�'
Owners Address Ownees E-mail Address
2520 i s / eurvhat H l�YGl��ru .c
City - .(r m State G �" Zip �12� _ S Telephone _? Z �J a52 9 Q8 S
APPLICANT'SNAME Last-:34 First 1Pilo-blogllk:1:16I'j(a'
Applicants Address Applicants E-mail Address
City State F7_7 Zip F ,Telephoner
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's Address ArchitecUDesigner's Email Address
City State r Zip �— Telephoner
ENGINEER'S NAME Last N First F- Lic. No.
Engineer's Address Engineer's E-mail Address
City State Zip F Telephone—
CONTRACTOR'S NAME/COMPANYN ,t'j�_ _ ^ A Lic NO. F Class
Contractor's Address IVGGCJ ConnCtYracctor's E-mail Address
City State 'Zip r Telephone—
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
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