HomeMy WebLinkAboutX2017-1958 - Permit Applicationr- Comm'I
rBuilding
Y 20 l'1 - 10 54
Worksheet for Combo Building & Solar Permit Application "
CS' City of Newport Beach - Building Division
Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_ Grading XDrainage F- Elec r Mech i _ Plum Cu Yd cut Cu Yd Fill
Address (Not mailing address) Flood F_ Fire [- Liq F- Landslide F_N/A Floor Suite No
of Work
New/Add SFF— Remodel SF �—
Use Const Type
# Stories F__
# Units (if Res)
Valuation5
Garage/New/Add F— Material/Labor
OWNER'S NAME Last ��tYC�L�ot J SiYP�� DIN , First
Owner's Address Owner's E-mail Address ^�J
no
city �(.L _ State , �- , - _ Zip C� 2��' Telephone 1��_,
APPLICANT'S NAME Last
Applicant's Address
City State (
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
city State
ENGINEER'S NAME Last
Engineer's Address
I
City State
CONTRACTOR'S NAME/COMPANY
Contractors Address
city I C)PhA
SETBACKS REAR
SETBACKS LEFT
First
Applicant's E-mail Address
Zip �—. TelephoneF—
First F_ Lic. No. �—
Architect/Designer's E-mail Address
Zip F— Telephone
First Lic. No.
�—
Engineers
—E-mail Address
Zip Telephoner-—)
T4,cro- PeAtt,
Lic No.C.'1 $L23-1 Class
Contractor's E-mail Address
1
State 1 Zip {q Telephoner, (i
SETBACKS FRONT PERMIT NO. 4r(�11H {�(Gj�.
SETBACKS RIGHT PLAN CHECK NO.
DEVELOPIv1EN,r NO __ .PLAN"'CHECK'FEES $___ .