HomeMy WebLinkAboutX2017-3492 - Permit Applicationx2D1�- 3�1,112
Worksheet for Combo Building & Solar Permit Application ��Po�t
i Comm'1 ;Residential City of Newport Beach - Building Division _"
NOTE- PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading F-Drainage r-Elec rMech
F- Plum Cu Yd cut Cu Yd Fill[_
Project Address (Not mailing address) Flood
F Fire r Liq r Landslide f_N/A Floor Suite No
F F_
II A-
Description of Work
Use 3, Const Type
I �
# Storiesl # Units (if Res)F
Valuation $
Materiai/Labor. �1Opa
( �
N,-W +✓ ��r� '� C
1^bilILnn;
WI m4 -A-k I
New/AddSF/ Remodel SF�— Garage/New/Addy—
OWNER'S NAME Last, C�T� top,
First "t.464tC
Owner's Address
Owner's E-mail Address
City State I GfL
Nc ��;i:tE
Zip Z��p Telephone!
APPLICANT'S NAME Last n "DF1r°r�
First
Applicant's Address
Applicants E-mail Address
7 b� F. l ✓�✓- A N f - I L?
'
{2-( A+-} 2 0 k.�, rh*0 -r
City State efa
Zip � 7)' Telephone 7 i 2 L %
i?'J{ 1`7L�oµ.1
ARCHITECT/DESIGNER'S NAME Last C >
�Q-10/ First I Lic. No. G - L771 r
Architect/besigners Address
Architect(Designer's E-mail Address
I
City I State
Zip I Telephone
ENGINEER'S NAME Last j 1.-0
First I �' , ; - 6,, Lic. No. S
Engineers Address
Engineers E-mail Address C 71
City . State ll
Zip `��_.}—TelephoneiQ,�I �_� nn-�
CONTRACTOR'S NAMEICOMPANY 6 ,Lv G {Lic. No. Class
Contractor's Address
Contractors E-mail Address
I
I
�T State G�
Zip 1 I Telephone1 q4c .1710
1,
SETBACKS REAR SETBACKS FRONT
PERMIT NO. XV t� 'r t l'2,-
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. q4/ 0.mi
I LISE ZONE DEVELOPMENT NO
PLAN CHECK FEES S