HomeMy WebLinkAboutX2017-2280 - Permit Application1614.011
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 croa�s
Building F_GradingFDrainage F,Elec F_Mech F -Plum cuvdcut cuvdFill
Project Address (Not mailing address) C Flood F- Fire F- Liq F, Landslide F -'N/A Floor Suite No
Description of_Work
Use Const Type
# Stories! # Units (if Res)
Valuation $
New/AddSF� RemodelSF� Garage/New/AddMaterial/Labor�i
Ill7TROAr
OWNER'S NAME Last �j�� First m ^q,A
Owner's Address
Owner's E-mail Address
cityT
_ _''., State Zip �iwECJ'_ TelephoneCC�l.��' y%�q
APPLICANT'S NAMELast FT First E1/
G1 R_I Z l E7 / LCC A
Applicant's Address
Applicant's E-mail Address
2gL4_► C -la Lam_�&F
CCr9»
City L.LS __.1-1 SR ------
__-__',' State [C,4 ZipC 66U_ - Telephone 9Ln) '712-/_1Y5
ARCHITECT/DESIGNER'S NAME
Last Firs Lic. No.
Architect/Designer's Address
ArchitectlDesigner's E-mail Address
City �10� _._.-._.._.
! State — Zip" Telephone._-_ _�-j _0'C (0,C j --S
Last �C_. _O-�F�S 1/A ��.�� Lic. No. _� ;
ENGINEER'S NAME • ` -\
Engineers
Engineer's E-mail A as
g'
City
- State F' Zip rs Telephoned
CONTRACTOR'S NAME/COMPANY L> r_ Cr pST CUN�A Lic. No. Ic{j�; Class
-f
Contractor's Address
Contractor's E-mail Address
City 1Sg
State [ Zip 92(� Telephone�)
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $