HomeMy WebLinkAboutX2018-0356 - Permit ApplicationX 2,01V - ®-3� 0
Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division o
r Comm'I 1 Residential NOTE- PI AN CHECK FEES DUE AT TIME OF SUBMITTAL
F -Building F_Grading rDrainage F_Elec Mech
[-Plum Cu Yd Cut Cu Yd Fill
ProjectAddress (Not mailing address) C Flood
F_ Fire r Liq La))))))ndslide [N/A Floor Suite No
65
Description of Work
(I�
Use F_ Const Type
rVaw �' T -ALL-
#Stories #Units (if Res)
Valuation � r� 0O�-
Material/Labor r
New/AddSFF— Remodel SF�— Garage/New/Add—
OWNER'SNAME Last L'AR%ST-ez Q5eJJ First) 1-91S
Owner's Address
Owner's E-mail Address
39 O.S P4A L6
city State I CQ,, _
Zipq2�- Telephone 9LI9- 3OZ_11+31 949 -e87 -
APPLICANT'S NAME Last F
First
Applicant's Address
Applicants E-mail Address
city State �—
Zip F— Telephone�—
ARCHITECT/DESIGNER'S NAME Last
First F— Lic. No. F
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
City, State F—
Zip Telephoned
ENGINEER'S NAME Last
Last
First Lic. No.
I
Address
Engineer's E-mail Address
city State F —
Zip F Telephoned
NAME/COMPANY fi b$
Lic. No. qq 7755f, Class) g�-z7
CONTRACTOR'S �Qp�
Contractor's Address
Contractor's E-mail Address
f�
$r_LL146id✓✓_. G*,4zI> I{1ZOSLC., COU -4
City NCA �Q- State l�
Zipj �I-IC)q-Telephone-7/ag2`�3-�LC�
l
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
'.�.USEZONE. _- _.. -.. DEVELOPMENT NO
_.-. ._.. .. ....PLAN CHECK FEES '..."" ....,.