HomeMy WebLinkAboutX2017-0167 - Permit Applicationi �«
Print orm •Worksheet for C mbo Building & Solar Permit Application �, M
F- Comm'1 residential City of Newport Beach - Building Division x,2o/ %-016'7
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL G.•.�.�•'
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Project Address (Not mailing address) r Flood r Fire r Liq r Landslide f9l�I/A Floor Suite No
1C33(o Po2T S(-tel-,p(ew I v
Description of Work
Use ConstT e It'3 yp �—
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#Stories#Units (if Res)
96MOL45,1'l 6 ws . CT.C-,<,(Mwm pmao colt emus T New�
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Valuation $
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New/Add SF �1O � SF�� arage/New//Add 24p
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OWNER'S NAME Last Jlb 5(o ?OCT SN�'Fr_ leTrLUS_
Owner's Address Owners E-mail Address -1n 29
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C/0 O&Vt0 0044M04114 A9C,41725G"r
City 54th R.7;5"W State F Zip F_ Telephoned '
APPLICANT'S NAME Last �ma j.( f First I P&Jl10
Applicant's Address Applicant's E-mail Address
19l t/ -'%L u -5P ft L/6 •20( ti(aol-kolAr-tN 0 e -mc c-c4to&(-i4er
City r60-3'Aesd State GD. Zi Tele hone
M zip,F p 1/4-?sEl3Goo
ARCHITECT/DESIGNER'S NAME Last 4kotAM414 W First e,�' �- j
'r% Vli7 Lic.No. C2v l
ArchitecUDesigner's Address Architect/Designer's E-mail Address
15, (Lem M u s 2(u� E -zo1_ o iottwlo" 4 %X VIo'oC2A1,-Ur0r
City e0STA mesw State F4�® Zip 4�* Telephone -7(k -2.j ( -54 00
ENGINEER'S NAME Last 1=1AU $IIADI First A2RAP Lic.No. _?llv2)`-[U,
Engineer's Address Engineer's E-mail Address
(gDc rw mp %T evrs t✓ T7A(2k(A0 (0 pe nth. Cogq
City 1SAts-ra wk State I- Zip q2,p I Telephone j 6-65 •2400
CONTRACTOR'S NAME/COMPANY -r014 \1VRI.6$4T(t4ti Lic.No. p iW5 ClassF
Contractor's Address Contractors E-mail Address
Joo GaM\'44-1001 Tally (Di0NYYAG&t4TIN4(CoT4c re rT(OA) . CON
City cowt44 boli MAA- State I v Zip q?-GZrS Telephone q¢% 127) &4-4q
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ I2 -Sl!• nD
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