HomeMy WebLinkAboutX2018-1742 - Permit Application (2)1J
X2D18- I��IZ
Print'Form : Worksheet for Combo Building & Solar Permit Application
❑ Comm'I kResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building ❑ Grading
rroject Address (
22.5- V I A
❑Drainage ❑ Elec ❑ Mech ❑ Plum
Cu Yd Fill
It mailing address) ❑ Flood
❑ Fire
❑ Liq ❑ Landslide
❑N/A Floor
Suite No
QDO soU3), N,3,
CA.
z�& 3
0
F
of Work
Use F7 Const Type F7
`� LINC VLOcV- WALL. 9+�rZ- --/�N�-��
n fr,\, ��� l i f� 1 1 #stories❑ #Units (if Res)❑
r �
Valuation �n
New/Add SF jtl(�- Remodel SF Garage/New/Add rc/ f} Material/Labor
OWNER'4NAME LastI 01X1 FAM ILT"5f-First -P(Nyr
Owner's Address Owner's E-mail Address
g0� uT �PtYF4LoL $ I R KE -T o IERN I551 . CoM
Cityi�f3otr 1- ULAY O State t!'�' Zip `TZfo&? Telephone
APPLICANT'S NAME Last I 3,K t'(31 Cv—( I First OA -64— I
Applicant's
A -i? 4—
Applicant's Address Applicant's E-mail Address
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City �o rState Telephone �(/g�, jS� —g (�
(21t s Zip Z�
ARCHITECT/DESIGNER'S NAME Last S (p(_ First �� Lic. No.
Architect/Designer's Address tt Architect/Designer's E-mail Address
[ b 3 0 L_0 ijeTA DE (y L,- It,
City F 17)leL MA -C 7 state Zip Zp/ Telephone R,--�7S�_9 37_
ENGINEER'S NAME LastS P QO-f-ASSbG, First (,O�LL(f�l� Lic.No..S3S(2
Engineer's Address Engineer's E-mail Address
Z3 0(LC {4Pt20 SuITe Z5D S„(<A5-HANiC�)W5()-SE.COM
city�� �y1�Si1 State zip� Telephonegg9-7_0(,-9?Z
NAME/COMPANY CnkSr C C)�Jae_Tc- Lic. No. --7i Qj Class
Contractor's Address Contractor's E-mail Address
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City �lSTmN State ® ZIP gz(a7s Telephone -!7"I_�J_3�7
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT �( SETBACKS RIGHT
USEZONE DEVELOPMENT NO
(4 PERMIT NO. )<Zo l6 —17q'
y PLAN CHECK NO. `j2--LCiI
PLAN CHECK FEES $
jpitm k �2& 16 3 r
SK -FB
( jC, 550 -
DQI: 5 -
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(z,S. M,
V&9
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