HomeMy WebLinkAboutX2018-3676 - Permit Application (2)PrinfFotm Worksheet for Combo Building $ Solar Permit Application ON
j- Comm'I r R/'4 -U 1� �7�City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j -Building r Grading [_Drainage 10ec [_Meth j- Plum Cu Yd Cut F_Cu Yd Fill
Project Address (Not mailing
address) r- Flood j- Fire r Liq r Landslide FN/A Floor Suite No
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Description of Work
Use F—Const Type F_
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N16-4 WALL
# Stories #Units (if Res)
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Valuation
Material/Labor 5 5-1000
New/Add SFr-®` Remodel SFF--®-- Garage/New/Add
OWNER'S NAME Last
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Owner's Address
Owner's E-mail Address
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APPLICANT'S NAME Lastr_r1j
- First ALi,IS o J
Applicant's Address
Applicant's E-mail Address
201 (�uf�o,�tT' 7►2• 15D �►.g,L,A.ZE�-@ LltiliaovDt;'�.rErlilE�,t2tnlh•
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ARCHITECT/DESIGNER'S NAME
Last--�
First Lic. No.r _--_m_
Architect/Designer's Address
Architect/Designer's E-mail Address
City
State F_ Zip [ _ Telephone
ENGINEER'S NAME Last I
J'17=i C� f W� First Ra 6E�T Lic. No.
Engineer's Address
Engineer's E-mail Address
2361 I�vPoNr jJtz. 1 S0 )2-"Z,14 (2, L-irQWoo l2�talbdn►6:62)/+5
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CONTRACTOR'S NAME/COMPANY
/ Lic. No. 04{! Class
Contractor's Address
Contractor's E-mail Address
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CityGl �j&&
State Zip fq L Telephone
CP
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $ l