HomeMy WebLinkAboutF2017-0041 - Permit ApplicationAYtul-krs'ver ►t.r44'e 17'
Worksheet for Combo Building 8r Solar Permit pplication�gW"°^;
(- Comm'I r-1Resitlential City of Newport Beach -Building Division �S
NOTE: PLAN HECK FEES DUE AT TIME OF SUBMITT
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Pro' ject Address (Not mailing address) ,E, Fllood , F -j Fire F-Liq J andslide /F-N/A�Floor
- Suite No
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Description of Work Usesi Const Type
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j # Storiess # Units (if Res)[
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-valuation $-
1 New/Add SF Remodel SF Gara a/New/Add l Material/Labor��
OWNER'S NAME Last t% h 5. oma l '' First s v III
Owner's AddressFrOWner's E-mail Address' j
City State Zip Telephone C%' i9
L APPLICANT'S NAME Last First
Applicant's Address Applicant's E-mail Address
City�,.� State G Zip: G a/L(_ Telephone 9. zC7 O
ARCHITECT/DESIGNER'S NAME Last First �e/ Lic. No
Architect/Designer's Address Architect/Designer's E-mail Address
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City rv—fil ✓ StateGt� Zip I L1Pf I Telephone q jq,°JiG s it
ENGINEER'S NAME
Last �,� I First / ern, Lic;No.�
:Engineer's Address Engineer's E-mail Address
City, State L(17' J Zip:RUP-T Telephone _7`7y(�
CONTRACTOR'S NAME/COMPANY Lic. No. F __71 Class,
Contractors Address Contractor's E-mail Address
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City State F I Zip Telephones
SETBACKS REAR SETBACKS FRONT PERMIT NO. r'Ly I Q bti(
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE" DEVELOPMENT NO PLAN CHECK FEES $