HomeMy WebLinkAboutX2018-3845 - Permit Application6
Worksheet for Combo Building & Solar Per lieatiol1
I- Comm'I j-Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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f-Building r Grading '-Drainage r✓tiec (-"Meth Glum CuvdCut /
CuYdFill
Project Address (Not ina�eiing
address) r Flood (- Fire r" Liq r Landslide IF_N/A Floor Suite No
Description of Work_ _
CC'�ft
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Use G{e5. Const Type (/
it Modes[ Z_ j # Units (if Res)[ ---
Valuation $
Material/Labor �lr
New/AddSF�L — Remodel SFr -PS Garage/New/AddF -
I YW
OWNER'S NAME Last First G�i✓ S
Owner's Address
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Owner's E-mail Address
cityw�c'✓� �
P c z'q C
i State L � �
Zip 2 b Tele hone 6 t"1 10- 6 �7
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APPLICANT'S NAME Last -.
TR... ,,. _,. _ - -_ -- First r 6C29& C
Applicant's Address
2 .__.Cu IL/e r
Applicant's E-mail Address
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Je t en�iTezphon
4
I men
City ` vY n c=
-.I State I `d"- jib Zip 9 L(p04 Telephone
71 ¢�'-] j y _moo f'•7
ARCHITECT/DESIGNER'S NAME
Last j _;C���. First r
Lic. No. .-- -,
Architect/Designer's Address
Architect/Designees E-mail Address -
City �
State F Zip [� Telephoned`',
ENGINEER'S NAME Last
'Se,.w---� � � ,�.n��� C First
U"
Lic. NcC�i_04,
Engineer's Address
Engineers E-mail Address
City �_- -_ - -
--__ State '; Zip y Telephone[
- -
CONTRACTOR'S NAME/COMPANY
Lic.
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No. �.5�7�%� Class �.
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Contractor's Address
Contractor's E-mail Address
City
., State Zip F Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
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SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $