HomeMy WebLinkAboutX2014-2284 - Permit Application60O1 - UCM
Print Form Worksheet for Combo Building & Solar Permit Application QWER"')Comm'I r- ResidentialCity of Newport Beach -Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r—Grading r—Drainage r`Elec rMech r'Plum CuvdCut F cuvdFill v
Project Address (Not mailing address) r Flood F- Fire r Liq r— Landslide rN/AFloor Suite No
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Description of Work
Use ConstType
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# Stories', # Units (if Res)[_
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Valuation$ "IAR,p• CCI,
Material/Labor "t1�.lo�.J
New/Add SF Remodel SF Garage/New/AddI
OWNER'S NAME Last t j G t First
Owner's Address Owner's E-mail Address
City 2�vv/�_ State ! 6T ZIP �'Z,�Z._.. - Telephone—_—_-....
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APPLICANT'S NAME Last _ VA V),Vk First 3c,
Applicant's Address Applicant's E-mail Address
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City ���7—C��j� State �� �^1 Telephone C^
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ARCHITECT/DESIGNER'S NAME Last "( y4 iz First Lic No.
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Architect/Designer's Address CKrVI N CX+Wt fl('tl t Architect/Designer's E-mail Address
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City m0 _ State I CNP�-—Zip CAZ(o7, Telephone66[4q)61�0-'.S<6()%
ENGINEER'S NAME Last _ ... __.. _ First I ', Lic. No.1
Engineer's Address - Engineer's E-mail Address
City �— State f .� Zip F_ Telephoned,
CONTRACTOR'S NAME/COMPANY OVI 06r, . Co /-- n � yL Lic No. Class
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Contractor's Address Contractor's E-mail Address
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City ��UN ��_ State �Zip Fq Telephonej qq� '
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO IlP PLAN CHECK FEES $
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