HomeMy WebLinkAboutX2017-3769 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
1— Comm'I 7 Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[—Building j Grading j—Drainage [-Elec [-Mech [-'Plum Cu Yd Cute— Cu Yd FillF_
Project Address (Not mailing address) [- Flood r" Fire (— Liq [- Landslide [N/A Floor Suite No
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i l00 `N. eoArT HV-Y sT6 IOZ
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Description of Work
Use I !1 Const Type
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A S-SE
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#Stories # Units (if Res)
Fo �- /h n�/ spry
rc a �FI�s 1"1 INS.
Valuation $
Material/Labor'
New/Add SF
I rod S
Garage/New/Add
OWNER'S NAME Last i '��
l
_ First I
Owners Address
Owners E-mail Address
1100 w .��� sT� . ioz
City I �.(eOK-T- REA-Ct.P State L-A
Zip c j 3 Telephoned -
APPLICANT'S NAME Last f=`
First
Applicants Address
Applicant's E-mail Address
1 12-
&,- &_ cvc
City 1 �•U l State
Zip, ciq— Telephonel C"
ARCHITECT/DESIGNER'S NAME
Lastp�i E/(�,First I Lic. No.
Architect(Designers Address //
Architect/Designers E-mail Address
1 2- t7� SCl(2
ik �o�c • 1�4 F-T
City _ , rj v , 1 State ,G}i
Zip �� Telephone Zl 9 _ 7 cLo—
ENGINEER'S NAME Last ►'jp t Iq rp First Lic. No.1 7-
Engineer's Address
Engineers E-mail Address
City : 1 Q2-- (/,�c State 1
Zip oy� Telephoned
l
CONTRACTOR'S NAME/COMPANY
Lic. No. 'j ( 3 (CJays
l�
Contractors Address
Contractors E-mail Address
City - State
I
Zip Telephoned
SETBACKS REAR SETBACKS FRONT
PERMIT NO. XQo
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
P! Ary .HP-K FFF-q-G � ��I �I•�