HomeMy WebLinkAboutX2014-3223 - Permit Application-�-z75
Worksheet for Combo Building & Solar Permit Application °QEWP°Rm
.0 Comm'IResidential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
uilding r Grading ( Drainage F-1Elec FMech Plum Cu Yd Cut Cu Yd Flu I J
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Project' Address (Not mailing address) CJ Flood ( Fire [ Liq ❑Landslide FlogSuite No
escription of Work
Use FTZ I ConstTy
# Stories # Units (if Res)
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Valuation
Material/Labor /
New/Add SFF-------7 Remodel SF Garage/New/Add F— I
OWNER'SNAME Last First -r6
Owner's E-mail Address
Owner's Address('
mm,
3 Sri R _QIVJA / 5T9
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State Zip.. •j„(�j'. Q, Telephone
APPLICANTS NAME Last un Gly) J First
Applicant's Address Applicant's E-mail Address
10 56 C., 6�
City %L State L �" ' J ZipZ b j Telephone 6 a%
ARCHITECT/DESIGNER'S NAME Last F� P% FirstPA L f n� Lic. No.
Architect0es gner's Address Architect/Designer's E-mail Address
a� 4�✓ � �Lr�- I!*�ehs2 ,
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City !N -%IL -®.o StateI� Zip'T (p l7 o Telephone, _-`?'( 6j 3
ENGINEER'S NAME Last' J First Lic. No.F
Engineer's Address Engineer's E-mail Address
1—Q -C-- — --- _ '� r r/tw W31 -0 -
City
ity __ J State Zip Telephone_34 (_5 G
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ONTRACTOR'S NA /COMPANY GPIZS j�1 CZ,i 1 N. No 5��3 Class_ %� J
Contractor's Address ' Td kv 3r. Contractors E-mail Address
1 4 ` Pvea1t51Ac. ccs(
City �GA9 '' State rZip � / Telephone /� 2 -fid 1
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE.ZONE - DEVELOPMENT NO PLAN CHECK FEES $