HomeMy WebLinkAboutX2016-0794 - Permit ApplicationPant Form Worksheet for Combo Building & Solar Permit Application
[- Comm'1 I— Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL .COLE k
[—Building [-Grading [-Drainage [-Elec r"Mech [-Plum Cuvdcut gip Cu Yd Fill
Project Address (Not mailing address) [- Flood [- Fire [- Luuiq [- Landslide [-N/A Floor Suite No
F
Description of Work @IFR fl
Use Const Type
Q�' 1 /��i W ^I/_ C�GJ.I:�J I.ICL�✓�'T/�G�'f./
# Stories #Units (if Res)
r-7Vf; ,,q i MW, I
Valuation5
Material/Labor /! ��
New/Add SF/l
Remodel SFF_Gara � a/New/Add
�� g G
OWNER'S NAME Last !-^,/I VJV�50 V First 04AIlf6
LAS
Owner's Address Owner's E-mail Address
3fq�g ✓`��
'19,bwA5
City St C
i xo llseiSIQ r+ -_ ate � Zip ?'Z 5o+ Telephone 7I + 3 zi r7 Z27
CJ
APPLICANT'S NAME Last I lV4.5SAko First
Applicant's Address Applicant's E-mail Address
Z55 f.v8� La✓ 46n n r�xrsh,llsta,�am
-
''
City 'OS,7 -. State Zip Telephonef
ARCHITECT/DESIGNER'S AME Last First Lic. No.
�i937�
Architect/Designer'sAddre s .S.<1✓4� A5" f1fPLJG4n' Architect/Designees E-mail Address
City State F__ Zip F— Telephoned
ENGINEER'S NAME Last C T FirstVf-7Z1 11,Y Lic. No. C� Z tj
Engineer's AddressEngineer's E-mail Address
p
�. GS /� SUiL✓LI.A/GId(�/G�i +L'�.. r�� iO��SM4nJ, �-,
Cityr- y-US7✓� (l State �— Zip 9 Telephone/7!A_� f�q
CONTRACTOR'S NAME/COMPANY /�/J7��Fi Lic. No. � Y20.7 ClassFR
Contractor's A/dddress Contractor's E-mail Address
/. ✓ /iAL(ri!/� ,� f Sr/%J �. 060
City �S,J-✓i ✓�� State- Zip ya�lfp Telephon 7jL}-% �, IZZ,yY
SETBACKS REAR SETBACKS FRONT PERMIT NO.
B LEFT SETBACKS RIGHT PLAN CHECK NO. W
E DEVELOPMENT NO PLAN CHECK FEES $
W6l )