HomeMy WebLinkAboutX2018-0767 - Permit Application (2)Armt Form Worksheet for Building & Solar Pet
r7 Comm'IResidential City of Newport Beach - Building Division
rv—INOTE: PLAN CHECK FEES DUE AT TIME OF SUBI
Building ❑ Grading [Drainage
Address
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Description of Work G p GJ JJt�(*y kUlf 1V
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New/Add SFF Remodel SF Garage/New/Add
OWNER'S NAME Last 1 C -,-u, „ First
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Cu Yd Fill
[N/A Floor Suite No
Use I Y JIm ConstType I 11S
# StoriesF, # Units (if
Owner's,Address
Owners E-mail Address
City HLsiWQ9RT (� State Zip q� TelephoneFqLtq- VX -UW
APPLICANT'S NAME Last
Applicant's Address
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City C/1C�0 State
First
Applicant's E-mail Address
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Zip aw—, Telephone _/y- !S- Z
ARCHITECT/DESIGNER'S NAME Last Vj tV! J FirstN tLt�[ L jSS 81
Lic. No. -
Architect/Designees Address
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City Cnl �GU State I
Architect/Designer's E-mail Address
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Zip Gi 2 � TelephoneFt6 8 tcz
ENGINEER'S NAME Last�ON V FirstI J Lic. No.(SSO _'
Engineer's Address
City_- \Tl !J _ State
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City 7 atte
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Engineer's E-mail Address
Zip ,_ Telephoneff/y-838-Y�25
Lic. No. F_7 Class
Contractor's E-mail Address
Zip F—Telephone
1,,q OMIT NO. �l`Z '- 010V
f PLAN CHECK NO. 01.4d,24% �
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $