Loading...
HomeMy WebLinkAboutX2017-4069 - Permit Applicationx2o17 - Ho&G Print Form Worksheet for Combo Building & Solar Permit Application Comm I r Residential City of Newport Beach - Building Division r NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL °<�oa.•' rBuilding r Grading Drainage _ Elecech Kplurn Cu YdCut l CuvdFill F_ Project Address (Not mailing address) Flood r Fir Liq Lalndslide rN/A Floor Suite No Description of Workl, V. rrl em9G,e u.) we+ fu� Use Const TypeFQ /7t ©Git a ° po r ef O — k 11 .C. # Stories', #Units (if Res 1 4,,Uasl"ev i3ed en4k 2cmDAd , S.New £v�rioY s CLv,sg s acco Valuation New/Add Sl'75 Remodel SF Garage/New/Add F Material/Labor n .n,Fl �..... `mss OWNER'S NAME Last I KL YY1 First l W(_ � A nnr� Own``ettr's Address Owner's E-mail Address � � oCJ City I /j efio P L) Y J�e- AO)F State CA Zip F— Telephone . `R C� � APPLICANT'S NAME Last IRichart Applicant's Address 1041 W. 18th St, (Al 06) City Costa Mesa State CA Firstliason �m yr U Applicant's E -mail -mail Address richartdesi gn@sbcgl obal. net Zip 92627 Telephone 949-422-9191 ARCHITECT/DESIGNER'S NAME Last Richart First Jason " Lic. No. Ii ArchitectMesigner's Address 1041 W. 18th St, (A106) City Costa Mesa State CA ENGINEER'S NAME Last IJAMIL Engineer's Address 751 SHASTA DRIVE City CORONA, CA State FA Architect/Designees E-mail Address Frichartdesign@sbcglobal.net Zip 92627 Telephone 949-422-9191 First I Bashar Lic.No.1 C 63 Y , Engineer's E-mail Address Q'_-0,c,�)3t2 G y Zip F— Telephoned CONTRACTOR'S NAMEICOMPANY �T�, .C�Lcr Lic No. 05 60 Class Contractor's Address (�N6 Fi. but I(-,- (4/ne AVE, _ City l AState' Contractor's E-mail Address Zip TelephoneF ��1-6-67Z1-1 SETBACKS REAR SETBACKS FRONT SETBACKS LEFTS SETBACKS RIGHT USE ZONE DEVELOPMENT NO PERMIT NO.l PLAN CHECK NO. �( PLAN CHECK FEES $ la,