HomeMy WebLinkAboutX2016-3199 - Permit Application (3)Worksheet for Combo Building & Solar Permit A plication
❑ Comm'I ❑ Residential City of Newport Beach - Building Division
NOTE' PLAN CHECK FEES DUE AT TIME OF SUBfVIII'TFCL Vf
Building ❑ Grading ❑Drainage F/E(ec Fetch ❑ Plum Cu Yd cutF_7 Cu Yd Fill n
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
g' 3 5 � I F-7
Description of Work
F{mPY %en C ✓akOr(V flee /CJD
New/AddSF Remodel SF
Use F7ConstType
# Stories❑ # Units (if Res)❑
(Valuation $
Garage/New/Add Material/Labor Y7
OWNER'S NAME Last �jXSct� /4jP+0.i N Sln i Vty First L_
Owner's Address Owner's E-mail Address
$2 t^ io Gee ss�op�rhy
City N�rN o 4- State Gry— Zip 9 gg ! Telephone .P74728g77,
APPLICANT'S NAME Last11 jmorl /rf t?f_e�_Ft tlj1 j►1 First
Applicant's Address Applicant's E-mail Address
CityG�2ach State Zip 82663 Telephone %ZZ pp
ARCHITECT/DESIGNER'S NAME Last B (61 RM k h a 1+ j Firsts UM Lic. No. C 32 $ 2bJ
Architect/Designer's Address
�/q 1- W1 i 1 i IycL 5+f G
City `(f Q b tfA 1 State F,
ArO,gc�hitectlDesigner's E-mail Address
y Suri,lE 1a�LV,Co✓\
ZiP gO63j Telephone 323 gZig3`,/y
ENGINEER'S NAME Last COL4,1`o First E-jva'id-0 7Lic.No.0 773
Engineer's Address
X20 00 ►(eo Wd
City State C
Engineer's E-mail Address
Zip 90Z�® Telephone
CONTRACTOR'S NAME/COMPANY b� P Q` �i Iat� I U SLic.No. C2 Class f}�B
Contractor's Address
/900 6usflv<'1PL
City PfPi _ state G�
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
torul,Cvlo� �? mom; (.Com
ZipW7®)I Telephone 9S! S65 6355
PERMIT NO.
PLAN CHECK NO. X09 . I a
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $