HomeMy WebLinkAboutX2016-3199 - Permit Application (2)Print Form' Worksheet for Combo Building & Solar Permit p licattiilon/v�'. ��t"W
�, Comm'I r, Residential City of Newport Beach -Building Division ���' V Y
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM<'oa"°
Building F Grading [Drainage �ec �ch r Plum cuvdcut cuvdFill C
Project Address (Not mailing address) f- Flood F_ Fire [ Liq i- Landslide F -N/A Floor Suite No
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Description of Work Use F Const Type
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# StoriesF- # Units (if Res)
Valuation S
New/AddRemodel SIF Garage/New/AddMaterial/Labor J/
OWNER'S NAME Last l M)tc ... M,94 1 :. ; <1.: re First
Owner's Address \ Owner's E-mail Address
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City N tv �D d �" _ State Ci� Zip 2�3 Telephone e�j-QZZ ]-
APPLICANT'S NAME
LastI iJCSO �Q - IV1V�iY1 First.
Applicant's Address Applicant's E-mail Address
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City LIL F's�u-x�V7 pqC� State �'�___.: ZiP 9L�� - Telephone /ff9 39-
ARCHITECT/DESIGNER'S NAME Last��a�mbB�a--°�----- _ I First .�Vdyti+. _ Lic. No. C9Z6z9Z
Arch itect/Designer's Address
City Q 1T(X ._.._--------- State
ENGINEER'S NAME Last t, 0L t 0
Engineer's Address
_622_
City Fh_ �_ (C1� State --
Architect/Designer's E-mail Address
/Ul�1L_ S v_rh i t _@ Ya AL CO✓+1 --
Zip X0639 ..-_: Telephone
First FFJ UAfd a - Lic. No. L 7737
Engineer's E-mail Address
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ZipTelephone 62 / mob_ -
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CONTRACTOR'S NAME/COMPANY �* I Lic. No. G2 z g7 Class
Contractor's Address
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city� �' , c- -- - - — - - _ state
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
tDYk,, cgma .Codes
Zip S7®. Telephone 9515656355__
PERMIT NO.r,�j
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $