HomeMy WebLinkAboutX2016-4113 - Permit Application®P orm I Worksheet for Combo Building & Solar Permit Application
F-" Comm'I r Residential City of Newport Beach - Building Division h�U � I I
I NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
ilding F_ Grading (-Drainage TZi(Elec rMech Plum CuYdCut F_
lect Address (Not mailing address) r Flood /F \Fire F_ Liq r Landslide
zg oZ P�Lz
of Work
Cu MM A I-i
New/Add SF F Remodel SF Garage/New/Add
OWNER'S NAME Last
Owner's Address
ZZ-/Z p UrNZu �ryn,Sz-t `t DtZ
City t'f_ Vv V___( `3E,� LT\ State L k
APPLICANT'S NAME Last
First I &A C
Owner's E-mail Address
Zip liii o
Cu Yd Fi
r /A Floor
Suite No
FR L-&
Use M Const Type I h 2
q Stories ' # Units (if Res)s
Valuation $
Material/Labor FLit,5500
First I `(—MA 1:> A L L_
-41i4s_
Applicant's Address Applicant's E-mail Address
tX I5C k9rL%_rzpt- S-r.I L�Iktl0&SPAG'rJ
City Oo TA E(E S A State A- Zip [ —lZ (—Z �
� 6 6 Telepho i�(4 �-Z (- t`t�C,
ARCHITECT/DESIGNER'S NAME Last Q14'rQ First {��
%�.- l� ticD 4k- C. L Lic. No. F6 ( I{
Architect/Designees Address Architect/Designer's E-mail Address
31p 6k-Z5-c06s-r.1.Ci� ZoS CL4�c�QS����f
City �aft� (t(� State (A ZIP Z6Z( Telephon S (f)4ZL-(-i4tav
ENGINEER'S NAME Last Ol•(A 10--C 0 First %
Lic. Not; 62 �c{q�
Engineer's Address Engineer's E-mail Address
366 -F Al2�(L`( Aqr, riC�t�QKi;NbK1(M�T�, tom
t',
City j c,& Ktj ,( State (� Zip 0I Z 6-Z,6 Telephon (LJL-( -(- Zt{ ZZ
CONTRACTOR'S NAME/COMPANY T. r? Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State F_ Zip F_ Telephoned—.
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
PLAN CHECK NO. ii-r 4 'b -
PLAN CHECK FEES $