HomeMy WebLinkAboutX2017-1900 - Permit Applicationi
Print Fo m Worksheet for Combo Building & Solar Permit Applicao tion Saw r Comm'I Rj'(/ Residential City of Newport Beach - Building Division yt7- \./INOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding r- Grading rDrainage rElec rMech F7 Plum Cu Yd Cut[ Cu Yd Fill
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
Description of Work
Use ConstType FTT
# Stories # Units (if Res)s
Valuation $
New/Add SF Remodel SF[___0_ Garage/New/Add � Material/Labor 0 (90
OWNER'S NAME Last I EtYJ i It kC'_ j_.Ll_L_ j First . . ... . ......... ..._ ......
Owner's Address Owner's E-mail Address
City 1'V i Uv. __.. _ State ZiP Telephon .. . QCJ . _ .. /7. 6
APPLICANT'S NAME Last I LL . First
Applicant's Address Applicant's E-mail Address
City � t State F(\ Zip If Telephoner � ��C/
ARCHITECT/DESIGNER'S NAME Last First�.
Lic. No. Q /
ArchitecUDesigner's Address Architect/Designer's E-mail Address
city State V-\ Zip : Telephone 6-q4 Se,( 2-IZ;7>
ENGINEER'S NAME Last r_:�G First Lic. No. L 15.31
Engineer's Address Engineer's E-mail Address
City l /Lr i A , �_ State Zip ��I Telephone � t�s-z'�b
CONTRACTOR'S NAME/COMPANY � A �t / J lL�� , j ,Y /7 �l Lic. No. �ti (�i� 3' ss .
Contractor's Address \t/h- (/�JCon�tractor's E-mail Address i�J
14 PAf(_V_.VtA9f�,i_ S L S d4,
City (�.` f L t b - State Zip Telephone ,Uq _
SETBACKS REAR i� SETBACKS FRONT PERMIT NO. v o 3
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $