HomeMy WebLinkAboutX2018-0291 - Permit ApplicationY201-013V11
Print Form' Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
r, Comm'I WResidential NOTE PLAN CHECK FFFS DUE AT TIME OF SUBMITTAL
P6uilding rL Grading rDrainage c ri Mech
[jt, Plum cu vd cut Cu Yd Fill �l
(/ Flood r Fire Li Landslide N A Floor Suite No
Project Address (Not mailing address) r r., q r F F_
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61,6vVY 1,67 i
Description of Work
Use ConstType Vr A
# Stories #Units (if Res)
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Valuation
Material/Labor �J•r�`' y W-
New/Add SFT, Remodel SF Garage/New/Add',
OWNER'S NAME Last ID
Firstl TOM,
Owner's Address
Owner's E-mail Address
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City ,rWli, if--- . State EN
Zip 1�62�...:. Telephone 1�`-?26-21Ji^
APPLICANT'S NAME Last First r-1
Applicant's Address
Applicant's E-mail Address
I96-iYl IA) 5T, 60rF 506
1rMa56,W6 mve,-a6free Gov 1
State _—'
City look_
Zip � Telephone 94 -��- J7i
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ARCHITECTIDESIGNER'S NAME Last K usuw(�rc� First Tumso5 Lic. No. C32N
Architect/Designer'sAddress
Architect/Designer's E-mail Address ,,"tom
k k0SUlMolu MVL- 4 re,4ifec(S 6b M
�%���iiMIA) JT. , :5vlAF $60 _
_ -
City l/0VIM57 _ State eA
ZIP %� Telephone fq-
ENGINEER'S NAME Last � _. _
.. _ ''�. First F_. • ��'...
Engineer's Address
Engineer's E-mail Address
City �� -_ -..... State
Zip �— T ephone �7,4.. -
CONTRACTOR'S NAME/COMPANYClass�'.
Contractor's Address
Contractor's E-mail Address
City State
zip �— Telephoned
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SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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