HomeMy WebLinkAboutX2014-1817 - Permit ApplicationX20 L,4 - (,S1-7 1301 4;?
Worksheet for Combo Building & Solar Permit Application
F' Comm'IResidential City of Newport Beach - Building Division n
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI
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Cu Yd Fill
CuiFMO
Iech�lt
Project Address (Not mailing address) f Flood
Fire r Liq
ndslide F -N/A Floor Suite No
loor
1-71
Des ription of Work
Use Const L J
#StoriesFI #Units(ifResf--]
New/Add SF ,-V,,10 I
(
Remodel Sly
rage/New/Add
Valuation $
Material/LaborF7 rhe AAN,-\n
OWNER'S NAME Last-- -
First
- -- -- Qom{- - -- -(--
Owners Address Owner's E-mail Address
City _ State F Zip Telephoned 5 20R
APPLICANT'S NAME Last
Applicant's Address
T? 8 --?I
City .` )L/iez _ State L`-'^' ]
ARCHITECT/DESIGNER'S NAME Last
ArchitectlDesignees Address
1-177
City- AVL_ _ l State
First I �--(A4Q.? ul!,',/r.)p
Applicant's E-mail Address _
Zip Telephone
First IrM/%JI Lic. No.
Architect/Designer's E-mail Address
Zip Te ephone - � -1
ENGINEER'S NAME Last e�i-.e - --- - I First `y hQ Z Lic.
- �
Engineer's Address
city t � _ J State
Engineer's E-mail Address _
Zip 2i Telephoned 4; ;7,
CONTRACTOR'S NAME/COMPANY — e, , _` Um Lic No. L Class
Contractor's Address
City t� State r Zip
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
_ ! Telephone 1'4 >-- �392
PERMIT NO. g ( 1
PLAN CHECK NO. I+ 1 I - vv I
PLAN CHECK FEES $