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HomeMy WebLinkAboutX2019-1143 - Permit ApplicationI'Y;nt Form �Worksheet for Combo Building & Solar Permit Application o4�" Comm'I [ Residential I - 1143 City of Newport Beach - Building Division 1 � , �g o NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL °uFo•^" rBuilding [Grading F -Drainage [X_Elec F-Mech F7 Plum CuvdCut Cu Yd Fill Project Address (Not mailing address) C Flood r Fire i- Liq F Landslide FN/A Floor Suite No 3900 Pacific Coast Hwy Description of Work Use Const Type # Stories / nits (if Res) cir cc nsls s o rep acing exis ing an a evesm oom Valuation $/ New/Add SFF— Remodel SFF— Garage/New/Add �— Material/Labor F$501000 OWNER'S NAME Last amd% 1 -ft L_Lw� First Owner's Address Owner's E-mail Address 1 Hoag Drive 1 Gery.Brooks@Hoag.org City Newport Beach State CA Zip 92663 Telephone APPLICANT'S NAME Last Liebke First I Steve Applicant's Address Applicant's E-mail Address 1340 Reynolds Ave. Suite 115 sliebke@liebke.org City Irvine State CA Zip 92614 Telephone 949-752-5052 ARCHITECT/DESIGNER'S NAME Last Liebke FirstSteve , Lic. No. C28341 Architect/Designer's Address Architect0esigner's E-mail Address 1340 Reynolds Ave. Suite 115 sliebke@liebke.org City Irvine State CA 9-752-5052 Zip 92614 Telephone49 ENGINEER'S NAME Last Zajicek FirstStephen Lic. No. E10372 Engineer's Address Engineer's E-mail Address 150 Paularino City Costa Mesa State CA Zip 92626 Telephone 949-852-9995 CONTRACTOR'S NAME/COMPANY CA fra Lic. No. Class C �© Contractor's Address Contractor's E-mail Address 2a$N S (Aticvd4. �' Che-ye.hne.® FaV_ouy C011(nC4%LOV� cam _ _ City 6*C Fo rCS t State op; --_ Zip _ q (p30 Telephone ��6 5�7� D 6?. - 101 —W SETBACKS REAR SETBACKS FRONT PERMIT NO. L O SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. Q USEZONE DEVELOPMENT NO -_._. ___.. PLAN CHECK FEES $----------