HomeMy WebLinkAboutPV2018-077 - Permit Application1653-za►S PM19-0-1-1
mom Worksheet for Combo Building & Solar Permit Application
F Comm9 r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r -Building r Grading F -Drainage F�Elec rMech r Plum cuvdcutCuvdFill
F F
Project Address (Not mailing address) C Flood r Fire r Liq r Landslide r N/A Floor Suite No
Description of Work
Use3 ! Const Type
# Stories ' # Units (if Resc
—(
Valuation -4o7�
Material/Labor
New/Add SF Remodel SF F_ Garage/New/Add r
OWNER'S NAME Last PF1 n CAb0jV4 First TCQl K
Owner's Address Owners E-mail Address
City _IWOt_�
S( V'•t.dl/ -.... _. State F C ZipFq_ Telephone y( 800(-31L'r
APPLICANTS NAME Last .(�t;_.rL�' First fG;;(e1nW
Applicants Address Applicant's E-mail Address
_ Oe)_I -- or-- 40
City A State Zip 3Q _ Telephone d ��49L1
ARCHITECTIOEESIGNER'S NAME Last _ First F Lic. No.
Architect/Designers Address Architect/Designers E-mail Address
City State F Zip F Telephone[ -
ENGINEER'S NAME Lastj First F __ 77 Lic. No.�'
Engineers Address Engineers E-mail Address
City _ - - _-- State �— Zip—� Telephone j
CONTRACTOR'S NAMEKOMPANY I �! �,p� (� Lic. No. Class
Contractors Address Contractors E-mail Address
t
J - --1
city � (�� r� � .; State �- Zip � Telephoned- 1 Z -
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N0.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $