HomeMy WebLinkAboutX2017-1395 - Permit ApplicationI
Worksheet for Cc%� rlbo Building & Solar Permit Appl icatioi
C't f N ort Beach - Building Division
y o ewp
j Comm'[ (Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
n 6���,
34�.om`.�
SETBACKS REAR SETBACKS FRONT PERMIT NO. Xao)
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USEZONE DEVELOPMENT NO Dzol�-at-oU PLAN CHECK FEES $
I�6uilding rading F -Drainage F_Elec FMech
F_ Plum CuvdCut � Cu Yd Fill
Project Address (Not m " 'ng d ess) f— Flood
F_ Fire r- Liq, r L s' a /A Flo Suite No
Description of Work
(7o.
Use �?j Const Type I g
Stories # Units (if Res)
-
New/Add SF{ 7�G�- 7 Remodel SF I3g2,/q • Gara e/ /Add,?
V
Valuation $ -- -
Material/Labor) s
OWNER'S NAME Last
- First I ��4'Cf �R Gy,U/J/IfF obpoo.
Owners Address
Owner's E-mail Address
/ TiGt�2CYv�'
City � � Cp T State c ',4
Zip Telephoner --
APPLICANT'S NAME Last 7jn/
First%._
Applicants Address
Applicant's E-mail Address
�?JZ3il1l Gil/Gprl .4�Cii/<Zz
AC15T/lIT" �
z73z C,.fS7 CO�4si ifl6�u�t
City' State G/-�
Zip I GI�y� Telephone
ARCHITECT/DESIGNER'S NAME Last C'j/1Gy5
v First Gjrd7lfm Lic.No.IC-
Architect/Designer's Address
Architect(Designer's E-mail Address
2732 ctJgr C'a'�7 W,45WI+h X f;P1Tt5 8
City C.6ltOA�H �� State I Cig
Zips 9 Telephonel gyl j._7iS j5�$
ENGINEER'S NAME Last i �HC�
First sJ�y��, Lic. No., 5 c�glzt
Engineer's Address ,5VG GIG/,Vr272/N�
Engineers E-mail Address
2Qp�2. G4r/,Nb ��+f /sf�►n/o su�TE' 21�� STcvEe 5�=��✓L-�z-'i—¢.r--.cu—rl
City Imo..,/6UL State ll
Zip 4� Telephone! y��- 9�9
CONTRACTOR'S NAMEICOMPANY I LLE /3 !Mi h2$iD J Co �Stquc nv J .yti Lic. No. �£{%(3 / Class
Contractor's Address i% („ kllt v -S te_ i) L/�
Contractor's E-mail Address Y r6,ZSTUaJZn/ C_ 6) n pL -(t
r
City) t✓uQthJA d2IVt'Iw�- State CcC,
I
Zips C-1 Telephonel �'r.(�L-ppZ�
SETBACKS REAR SETBACKS FRONT PERMIT NO. Xao)
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USEZONE DEVELOPMENT NO Dzol�-at-oU PLAN CHECK FEES $