HomeMy WebLinkAboutX2016-1986 - Permit ApplicationComm'I
[Building
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Worksheet for Combo Building 8r Solar Permit Application o4zEW�
Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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[Drainage ❑Elec ❑Mech ❑ Plum CuvdCut
F77
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Address (Not mailing address) ❑ Flood [ Fire [ Liq [ Landslide
❑N/A Floor
Suite No
OCMW
BGS WVA"
7
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Description of Work
PMexATtog) of 67XIlk-Wu SPfZI CpfJSTA,u�CT NEw 2 Sroty
SF2 01-110 gAs MQ/r, G DEcu tF A7fAGlfEP -c/►+l C�
New/Add SF Remodel SFF7----] Garage/New/Add
OWNER'S NAME
Last 2°128 0Ce*Pjj LLG I First
Use $P17L $17LConst Type n
# Stories p Units (if Res)F7
Valuation $
Material/Labor
Owner's Address Owner's E-mail Address
12o Tu�,rM/
41e. Sur onA �
City At67O81Ir 0741 State L J Zip %Zb63 !;. Telephone
APPLICANT'S NAME Last
Applicant's Address
City _ _ State
First
Applicant's E-mail Address
_J
ZjpTelephone
F_ _7d
ARCHITECT/DESIGNER'S NAME Last L �t!if{f'r —_ ,I First ii'# 61 Lic. No. 22 3Zi4,
Architect/Designer's Address
IWol Qgft 5r><.OM izo
City State
Architect/Designer's E-mail Address
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Zip i2(jc,p Telephone V'?_ 85F/_,s '
ENGINEER'S NAME Last First Lic. No.
Engineer's Address
City _ State
Engineer's E-mail Address
Zip Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. J Class
Contractor's Address
City L State F
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
Zip F j
Telephone J
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $