HomeMy WebLinkAboutX2016-0996 - Permit Applicationms�j i�01%) /)W-,
,Prim Form Worksheet for Combo Building & Solar Permit Application
Comm'I .!Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
I Grading
Address
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of Work
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Use sl�12 Const Type F
# Storiesw # Units (if Res)FT
I Valuation $ FSWI
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Material/Labor
OWNER'S NAME Last `3,C} First) (�
Owner's Address f dress`
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Owner'sE-mail Address !� /�6�G
Z 2W 464 1 r�up Cou �_ _ _
City I e,W �c, °x}�',. State FC4--', Zip F TelephoneF—
APPLICANT'S NAME Last ,AbkVV/ _._ ___.... First WI.LGk(OL)
Applicant's Address
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City LG VUe -I z,,e0,CC,,, _ _ State (24
Applicant's E-mail Address
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Zip c�Q(S Telephone S(eZ-1.�2e{ Z`�}`ro
ARCHITECT/DESIGNER'S NAME Last (%ya � 1 First I G kgj4 Lic. No. I
Architect/Designer's Address Architect/Designer's E-mail Address
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City T;0,j State 7 . _ _ Zip q0 4 ( Telephone
ENGINEER'S NAME Last (/1 First (r✓. Lic. No. s F60 O
Engineer's Address
City peho Jj W ell State 1 �4
Engineer's E-mail Address
Zip gQ ,77 Telephone 310
CONTRACTOR'S NAME/COMPANY �z�tl�� ( Jv , Lic. No. �5 �QClass
Contractor's Address
City ,yu)3 l (( (/\ State C ;
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
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Zip R0�IS Telephone ,�-&2_—V+220 ,e
PERMIT NO.
PLAN CHECK NO. I b I Lf —
PLAN CHECK FEES $