HomeMy WebLinkAboutX2013-0125 - Permit Application-U ac-.(' (. y /,ell v j
Worksheet for Building Combo & Solar Permit Application
City of Newport Beach - Building Division Vol
KComm 'I F_ Residenti NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL L -1c, �A
r -,Building Grading rainage F71 Elec F-11, Mech
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r- Plum Cu Yd Cut Fq�g�'EYd Fill F;;�
Project Address (Not mailing address) F Flood
F._' Fire F- Liq F- Landslide r7i N/A Floor Suite No
Fc)(Zr) C11 q
F F77
Description of Work
Use F_ Const Type F
Ek-' LAN i'X;( A
#Stories17 # Units (if Res)F—
New/Add SF Remodel SF Garage/New/Add
Valuation
Material/Labor
OWNER'S NAME Last
First
Owner's Address
Owners E-mail Address
0 c,
City 6 State
Zip F5 I _66 C TelelphoneF
F )LICANT'S NAME Last j
First
Applicant's Address
Applicant's E-mail Address
City rc_�f iT State
--7-) Telephone
ARCHITECT/DESIGNER'S NAME Last
First Lic. No. F_
Architect/Designer's Address
Architect/Designer's E-mail Address
City StateF Zip Telephone
ENGINEER'S NAME Lastfj�1_QS� jo,
First Lic. No.
k
Engineer's Address
Engineer's EXVXddr;!s 3Sb (q
Z-7 14
- I - __ - __ - - - __ � - . _ - . _ __ - - i
I A M 5, 11 6) C v
City r, 67 (( _L d4 State Zip
r,7—Telephone
CONTRACTOR'S NAMEXOMPANYly�1 jjk Lic. No. Claslf,',
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Contractor's Address
Contractor's E-mail Address
Ij
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Cit y State z
Telephone
i p 7 F 11 C 1,
4 k
SETBACKS REAR SETBACKS FRONT
PERMIT NO. -,o/;"- o /-2
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $