HomeMy WebLinkAboutX2018-3713 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application °4'Ua°tea
�/ City of Newport Beach -Building Division
r— Comm'l i—,,-<esidential/� NOTE: PLAN CHECK FEES, DUE AT TIME OF SUBMITTAL .�
,FxZlilcling i Grading FDrainage f Elec (— Mech ` o v- u cu r
Project Address (Not mailing address) Flood ire f Li X�q\andslide N/A Floor Suite No
`114 � - .L/OIli
9Z0'77 �_ F-
Description of Work -
Use i Const Type I
I
# Stories r1l# Units (if Res)lr
Tsip-� jA �4e--6
Valuation $
f
SF
r
New/Add Remodel SF
Garage/New/Add
Material/Labor r
OWNER'S NAME Last �j l //,r-,[�//L—
Firstl
m
Owner's Address
Owner's E-mail Address
_
City /�'v6 .�G j� State
Zip -Z,-j1of7 Telephone (?Zll? fl
APPLICANT'S NAME Last
First
Applicant's Address
Applicant's E-mail Address
City State
i
Zip TelephoneF_
ARCHITECT/DESIGNER'S NAME Last First <
� ti Lic.No.' GAL.
ArchitecUDesigner's Address
ArchitecUDesigner's E-mail Address (.
_
F67,1 G I—fi•4-Mr/I G
City �,K�ti �� State e-4
Zip 1 ,-7 Telephonei
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ENGINEER'S NAME Last �
�� �''7�
First � � Lic��ISr ."
Engineer's Address
Engineer's E-mail Address " ,I
Y
City 0 State F_
Zip r Telephone,F_
CONTRACTOR'S NAME/COMPANY s CIDY
,l
P - Lic No. lass�_
Contractor's Address
Ill UIO NoY__eRcar trv�y�
Contractor's E-mail dress
i0K. Gs t C&V1
City L� g-� --� State I ` �
Zip 2 (0 Telephonej1 4-C4 0-74- I
SETBACKS REAR SETBACKS FRONT
K
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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