HomeMy WebLinkAboutX2016-3200 - Permit Application� l � LIl''l>�w Print Form Worksheet for Coullding & Solar Permit Application
C Comm'I [ Residerttl I 32ob City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building [Grading [—Drainage [Elec [—Mech F -Plum Cu yd cut Cu Yd Fills
Project Address (Not mailing address) F- Flood F_ Fire F- Liq [— Landslide r__N/A Floor Suite No
13617L<15=3pa c� � ave_ face
Description of Work Use Const Type F
Ee r� I+==JE l 5'[•t trt� A4a4ed ictls S -l- ckf ?e ct �e�.'
# Stories # Units (if Res)s
g Valuation
New/Add SF� Remodel SF� Gara a/New/Add � Material/Labor
OWNER'S NAME Last 1 M 1� Ct.1_ i(lt` lYt' First
Owner's Address Owns E-mail Address
City N)ZWP�)f* _Jtft�&jState I `fir r Zip �oY�G'J Telephone
9 iia_
APPLICANT'S NAME Last
Applicant's Address
-------
City .__ - State I &S1 Zip
E-mail Address
\" ARCHITECT/DESIGNER'S NAME ;� `_ p
�, J; Last `k.J •i1tJ�1(, _-------- First Yu,;_E ' - Lic.No.stun
Architect/Designer's Address [�
City �CZ \y+yL-_--------_ -.- State
Arch itect/Designer's E-mail Address
ilY1lA_ rtn �Ca tiJ.---
Zip Telephone
ENGINEER'S NAME Last First IQ Lic.No. T`4-13_ ctrw-- C�4w---
Engineer's Address
City Lit t%i- - --- -- State I (-),8
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City -���- - - - - State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
USE ZONE
SETBACKS RIGHT
DEVELOPMENT NO
Engineer's E-mail Address
Zip _Ot(�n_ Telephone.
-ic.No. Class,
----w � S
Contractor's E-mail Address
Zip Gds_ Telephone -'-571
PERMIT NO, 7i0i 77 c
PLAN CHECK NO. X1,2'7 "j • 7. z �'
PLAN CHECK FEES $