HomeMy WebLinkAboutX2017-2604 - Permit Application�_W__N ' • OMNI
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Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
Comm'[ - Residential n,nro oI ANT r'HHCK FFFS DUE AT TIME OF SUBMITTAL
rBuilding Grading f-DrainagevFElec VFMech Plum cuYdCut'! CuYdFill
Project Address (Not mailing address) F Flood F- Fire j- Liq Landslide F _N/A, Floor Suite No
-1a -aus �tOMt•or��.�r �
Description of Work 1 _ Use i ConstType I
C_ s--'�- -i-� �e # StoriesF— # Units (if Res)�-
Valuation $ <�
New/AddSF� a jr Remodel SF il^ Garage/New/Add Material/LaborIS��=d
OWNER'S NAME rstl
LastT J 1 h2 CQ
Owners Address -c� SOwner -mail Address
City of V3 o.= j e.q.C.� State C' t� Zip �� Telephoned
APPLICANT'S NAME Last First
s QLd � l
Applicants Address Applicants E-mail Address
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City State j �??�"------ Zip F TelephoneF—
ARCH ITECT/DESIGNER'S NAME ; Ne.) \—T � �_—
Last !� 1 'C � �"Q�� h Lic. No.
Architect/Designers Address Architect(Designers E-mail Address
F
I
City, State Zip Telephone)
ENGINEER'S NAME Last i irstF—k'i Lic No� tl �cj
Engineers Address Engineers E-mail Address
City) is � State G,� ZIP al 's 1) Telephone' 9 A9
CONTRACTOR'S NAME/COMPANY Lic NoDa �'� L Class
Contractors Address Contractors E-mail Address
3\i110\ '`Jyz- Sar. _Juav� �3 ;ctSO 1�,N-9�e�ov\
CityiC0.�iS"1--a'1_O State i �'� zip ����� Telephone1 L�q
SETBACKS REAR SETBACKS FRONT PERMIT NO. l lX-Lq;lI-1 , 1AZD�JII
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. k����
i icr, 7nnlF nr %%,m nDnnPnIT Pin FLAN CHECK FEES $