HomeMy WebLinkAboutX2016-3476 - Permit Application016 - 36(76 19
Worksheet for Combo Building & Solar Permit Appiicat
F Comm'I Residentiai City of Newport Beach - Building Division N ar-j 7, -
r—
NOTF_: PLAN CHECK FEES DUF AT l?ME OF SUBMITTAL
$
�-
uilding ,Grading [-Drainage FElec j`�Mech plumCudFill 6i
� CuG.+7d Cut �r7 �j I
Project Address (Not mailing address) Flood ire C`I Liq i�ndslide 'N/A Floor Suite No
Description of Work
Use Const Type
#Stories 4Units (if Res
)s
New/Add SF G Remodel SF I Gara a/New/Add vl r,� X I Valuation $ I / O?E �Jf
�� 9 CJ Material/Labor V (,/Ci�(�CII
OWNER'S NAME Last First
44
Owner's Address -I
Owner's E-mail Address
City r,R.,c i, State Zip Telephone �'�,7 ,_ . f - -
APPLICANT'S NAME
Last �;��-V��>:r^x7 f, I First I/t^l I
Applicant's Address-----'
Applicant's E-mail Address
City StateZip Telephon
-—
ARCAITECT/DESIGNER'S NAME Last
�_ ojr_c� I First ,�f� Lic. No. �—
Architect/Designer's Address Architect/Designer's E-mail Address
City L..G.( �L`�'' -__.-- - .---I StateYom'^ Zip /�t� - I Telephone W�--= -
ENGINEER'S NAME Last First - Lic. No. --
Engineer's Address
City 11 . 15V ^'
Y_2 � � -- -----J State
Engineer's E-mail Address
Zip `(��.� Telephone
CONTRACTOR'S NAME/COMPANY I Lic No. s�Class
F
Contractor's Address Contractor's E-mail Address
L - __— _-__—Ji -------
City� _-_ _ State F— zip�—� Telephone
SETBACKS REAR
SETBACKS LEFT t
USE ZONE 2::�: I
SETBACKS FRONT I[ I
SETBACKS RIGHT vT /
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $
� �k. „-.� k�� j� ,-.�--
.,
2016 " -- 3K 6
Worksheet for Combo Building & Sar Permit Application
City of Newport Beach - Building Division y
Comm'IResidential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
}Building ? j_Grading rDrainage rjElec rMech
r-1 Plum cuvdcutb cuvdFill ID6J
Project Address (Not mailing address) r Flood
ire ❑ Liq a dslide CN/A Floor Suite No
y,L_ SETBACKS RIGHT
� (
Description of Work "
se L7 J Const Type
/i.l tl
# Stories #.Units (if Res)n
Valuation $
Garage/New/Add I Material/Labor
New/Add SF FF
OWNER'S NAME Last :/ J ' Firstj,
t
�✓
Owners
Owner's E-mail Address �"�
�Address
t
city�--- State
171 77'JV �%�% ¢2�
Zi Telephone
p ��� %3
APPLICANT'S NAME Lsat y� �
777::]
ApplicantsAddress
CityState Zip t
ARCHITECT/DESIGNER'S NAME Last Z�
First . /_" —J Lic. No.�
ArchiteettDesignees Address
Architect/Designor's E-mail Address.
T> WA 1_0 �
,dJJ�► 70 r� .,rzs
City �/�� J State Zip l' Telephoned]
ENGINEER'S' NAME Last
First Lic. No.� j
Enn/ggAiineer's Address `
E-mail Address
yEnnggineer's
City�N _ J State Zip ,_ ; Telephone
CONTRACTOR'S NAME/COMPANY
/fjJ / Lic. No. // ass ,
Contractor's Address
City ....v S late ZipI / J 7 -Telephone
,1
N TB l S REAR _
°rETST
2140)
i
( SETBACKS FRONT
I t
PERMIT N0.
y,L_ SETBACKS RIGHT
� (
PLAN CHECK NO. "
DEVE[OP NT -NO`
PLAN CHECK FEES $