HomeMy WebLinkAboutX2017-3853 - Permit Applicationx2U1'I- 3853 '�.
Worksheet for Combo Building 8r. Slolar Permit Application
City of Newport Beach - Building Division
F- Comm1 Residential NnTP- Pi AN CHECK FEES DUE AT TIME OF SUBMITTAL
F -Building F_Grading F -Drainage FElec F_Mech
F -Plum CuvdCut CuvdFill
Project Address (Not mailing address) C Flood
r- Fire [- Liq I- Landslide [N/A Floor Suite No
1/7 0A
Description of Work
Use Const Type
# StoriesF # Units (if Res)F—
Valuation
New/Add SF � Remodel SF �— Garage/New/Add �—
a
Material/Labor
OWNER'S NAME Last Zf^jQjTJV!1� First Mh6�
Owner's Address
Owner's E-mail Address
)) —]
t `
CityF5tE5-o-T6-Prz!;— State I OA
Zip F— Telephone Y63 qaq lf6,7
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State F—
Zip F_— Telephone—
ARCHITECT/DESIGNER'S NAME Last
First F— Lic. No. F—
Architect/Designers Address
1-77
Architect(Designers E-mail Address
City State �—
Zip �— Telephoned—
First �— Lic. NoF
ENGINEER'S NAME Last
Engineers Address
Engineers E-mail Address
Ci State �®
Zip �a Telephoned
CONTRACTOR'S NAME/COMPANY ?� I _4
Lic. No. ��7jk)Class?-7
ntractoorrs, Address
ContractorsE-mail Address -
q
Wr��lt
IrelloccA4-�th� e-
City State
Zip t' tX7 Telephone 714 _ <
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $