HomeMy WebLinkAboutX2018-2385 - Permit Application00 -;013 X9016-,2335
print Form '/ Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
Comm'[ (7 Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j/�ilding r' Grading rDrainage c Plum cuvdcut� cuvdFill �l,
Project Address (Not mailing address) rFlood r Fire r, Liq r: Landslide rN/A Floor Suite No
1 x"12 _CCS SUi 0 F r
Description of Work Use F' Const Type MW
# Stories #Units (if Res)
Valuation
�000 000\1 F[ Garage/New/Add�Material/Lab FIl
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OWNER'S NAME Last First.
Owner's Address l f'v Owner's E-mail Address
Ciry State Zip Telephone L'�"�t
C OACICA
APPLICANT'S NAME Last���( j First _ r
Applicant's Address Applicant's E-mail Address
NOM TA6I "n
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City I..... V ��-�.V �. State : Zip �'L4` 03 Telephone 7.1. ��.7 ✓�" 7 +J __-.
ARCHITECT/DESIGNER'S NAME Last _l r-f`C /�Y)CWr�jfp�/j First /r�`Jojjb Lic. No. � 1
Architect/Designer's Address t�� Arcch"itect/Designer'`s"E-mail [Address
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City � - State Zip �'12'�� Telephone Mol -j ` ....-� 1 ... -..,
ENGINEER'S NAME Lasti-V Last-Vrob j natf First �1 fjt '�(j(; o Lic. No. " l TV
Engineer's Address �_Engineer's E-mail Address
City _{'.Rn3 `nC/, .State (s Zip /n Telephone ��
'r" 1 V 1(s'IK� �,,y11��ny'! " � '/�/�, �--� �^y� v1% j�i Jam,""',
CONTRACTOR'S NAME/COMPANY / Lic No. ��i'iW lass F
Contractor's Address (/ Contractor's E-mail Address
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City MC C l l _ -StatICR
e—� Zip �u Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. �(� •�i4�
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $