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HomeMy WebLinkAboutX2015-3098 - Permit Application (3)Print Form �g� NOTE: PLAN CHECK FEESaDUEBu dingOFislon fit ��9 V(01i aOBB o W�rea Comm'I Resikential 3(Dgg yNewportg sion 3�FSSU vlrGj SUBMITTAL F,uilding j -Grading F -Drainage rElec �Mech �x Plum cu Yd cutCu Yd FiIIF Prrojjec t Addiress (Not pgalgling addlrress) J`- Flood 'F Fire r Liq F Landslide rN/A Floor Suite No Fy5o \jtc�% F --L- F Description of Work Use K-TLYA ConstType'jf.(3 I # Stories # Units (if Res)7 Valuation $ W100/6,00 (7007 Material/Labor 1 / 600 New/Add SF [-I, gpp RemodelSF� Garage/New/Add �- OWNER'S NAME Last �— First , I L L1 � � Gro�� �e} c �- C, Owner's Address Owner's E-mail Address ` �2 3,0t0 (V¢.wo✓"1 Svlt2. l©c) V`'Dr`1�Z2vY� ���C`1fI 1. ,S\vc- City StateC� Zip X26(,3 Telephone `jJ_$_Z3`f-�36 APPLICANT'S NAME Last First 3..y o cam( Applicant's Address Applicant's E-mail Address `79U � ��� PAv� Clrc�zl �JVlke ��e� SvvS- W c -fit La✓�I City �State C,� Zip °fZlfll�l Telephone Rye 3/57-�24c� ARCHITECT/DESIGNER'S NAME Last 5, First JoSt,P (� Lic. No. _-2-4 `l`( Architect/Designer's Address Architect/Designer's E-mail Address City State �� zip[—Telephone 9,N1. -151. 32y a ENGINEER'S NAME Last I First Ste" 0 e Lic No. LI-1-�-b Engineer's Address Engineer's E-mail Address {MSn6 Q44Ai1 -v-z_�SukE 2. b �A�.GRIMM@CzCSt1�VCtu�AL.Co City `�vState I CA Zip I TelephoneO`llQ CONTRACTOR'S NAME/COMPANY Lic No. �. ClassF Contractor's Address Contractor's E-mail Address City State F Zip I Telephone)--_- SETBACKS REAR SETBACKS FRONT PERMIT NO. SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ WWI