HomeMy WebLinkAboutX2017-1394 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application st
Comm'I Residential City of Newport Beach - Building DivisionNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
KBuilding I Grading j—Drainage F_Elec Mech Plum CuvdcutF cuydFill F
Project Address (Not mailing
address) 1- Flood ire r Liq r Landslide F_N/A Floor Suite No
F
I�i�
Description of Work
Use I Const Type r
# Stories #Units (if Res)
6n
to—y e, OL- a fio
p
Valuation $
U (/�
Material/LaborFo/
New/Add SF!Remodel SF Garage/New/Add
OWNER'S NAME Last I
M �D First
Owner's Address
Owner's E-mail Address
%
City �Qj,,,�fV" ("Of
State I C1. Zip' 4? -7 Telephoner gS� �
APPLICANT'S NAME Last
First I -TV yt y
Applicant's Address
Applicant's E-mail Address
�6q� �''CtW9kofa-,�. Gov
city I �✓ s^e
r,
State cA Zip q;y V6 Telephone ?(L7 755_7,�:3 Y�
ARCHITECT/DESIGNER'S NAME
Last A(9_-y✓r� First— LicNo.f
Architect/Designer's Address
Architect/Designers E-mail Address
1 15 7-0 (3roolc 4,)lov✓ I_
°"
�,t� �f� Lhu>^ aa�i'X eN� G�'
City r7C[i'I't•Ot �-n0-
^
State G�' Zip q,,,-10, Telephone 714�-662- —17 S(!�
ENGINEER'S NAME Last
N Q �( Ln� +n� First! Lic. No.r�
Engineers Address
Engineers E-mail Address
city
b
r——
State Zip �— Telephone
CONTRACTOR'S NAME/COMPANY i �W�y �NyfYc( Dn MA)i /nGLic. No. S( 71cCi Class
`` ��
Contracctors Address
Contractors E-mail Address
/
city _ ZYv ti 2_
State I C - Zip I q [ !
Telephone] qq . y7 rs �S�p�
iO
t/�PERMIT NO. —'�/
SETBACKS REAR
SETBACKS FRONT J U /
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. halb? i
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $