HomeMy WebLinkAboutX2018-2104 - Permit Application (2)X 2016 - Flo H
Pt;nt Forrn Worksheet for Combo Building & Solar Permit Application ��"°°�
j Comm'[ r Residential City of Newport Beach -Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL �• �.�'
jKBuilding r -Grading r -Drainage fT,Elec FA Mech ('i(PIum cu YdcutF Cu Yd Fill
Project Address (Not mailing address) r Flood r Fire r- Liq r- Landslide rN/A Floor Suite No
F F
Alf Zo GAMPuS 1712.1 Qe W)aWforT l7�/'d i 1 GPr 2(oCoO
Description of Work
Use i3 Const Type vim$
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V-EMop�t, PY t9rW.C7 pe1E' OF�I�i L4 W7tn16r %ory CZ)
5U 20 Lr. NUM
#Stories #Units if Res)
I ► 1
AN4 SIAL 20 15, 0E- A &e:R f -r'4. 7FF1� TF--R&Rr C r1j
I MpazoV l � f3UrR1' S(,L tTES•
Valuation $ 352, r o 4 cF A4
New/Add SFr Remodel SFF5 0\ 5r- Garage/New/Addf�
Material/Labor rF(Se"o0C•'"'
OWNER'SNAME Last t'ttFlr�N �iCbW'tT First
(QI.ATIKUM 6TalzldpE' Cq(�UP�
Owner's Address Owner's E-mail Address
2.1 co MAK 4TFe-G% 15iVk, I0ro
G{ua�@ Piai-ii<iuNt ztOra�e, .Coavi
City 112Li We State I 6A Zip j2Po(Af Telephoned(e�j.7-to 2y�jy4 �y
APPLICANrsNAME Last I gmToty First f -IG -
Applicant's Address Applicant's E-mail Address
2`500 511.Vef- Wkoiaa•ihGl'tl'(63fvwt't colvt
City it� � V r M16,C4 State [ e� ZipGI 24pteV Telephone
ARCHITECT/DESIGNER'S NAME Last V MT" First IZ I GSc. Lic. No. G' 1*sm
Architect/Designer's Address Architect/Designer's E-mail Address
?-.q 04) 5; 1 W V -F- L -Me G,aq•IY1c.1'I1'I@�wti{i •�oYv\
City I (tArrywfOit•v State r_,,�_ Zip Telephone gq4{. 6 -i -S- 0 7
ENGINEER'SNAME Last kjel,-fotA First ,� �fr�`f Lic. No. ;_; I
Engineer's Address Engineer's E-mail Address
26 `tfoj PP�i= � 9 TAY we\i-en G3 sf ire5ty LA4tures. corA
CRY L,74q� rypzvP-r State FZZ__ Zip i_Z- o Telephone `+, . �( l(0.344
CONTRACTOR'SNAMEXOMPANY / J „� /' ,, , Lic No. - � Class pj
V >f# 6Vy
a
EYyr
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Contractor's Address Contractor's-mailyyR��d,,,,tlress
1 �q;, W i i VQ . *—e,5k ,71M/Jia1)AZ (—.+�G—/fit 44m -
F7V7� TMj
city State I 1"Al b� Zip �Telephone I f l
SETBACKS REAR SETBACKS FRONT PERMIT NO. ,(-JTQ D`1
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $