HomeMy WebLinkAboutX2017-1407 - Permit Application0--7
Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division a
)- Comm'IResidential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
uilding r Grading F -'Drainage F- Elec (- Mech F- Plum Cu rd cut Cu Yd Fill
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Project Address (Not mailing address) Flood F Fire [- Liq r Landslide �N/A Floor Suite No
Descriptiolt of Work Use Const Type
YCkOi�r wail to C lQ .n
#'Stories # Units: (if Res)'
q� wants
Valuation a
New/Add SF ' 5;�Remodel SF— Garage/New/Add Material/Labor[-I 1000
OWNbrsNAME Last First o.kk,z vi'�o^ tlwnta�
Owners Address Owner's E-mail Address
City �SD (bl�a VQ\ (`I LC State ZiP �%,6-?,5 Telephone 'a�Q ` Ibb -1 lQi
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APPLICANT'S NAME Last First
Applicant's. Address Applicant's E-mail Address
City State r Zip r Telephone
ARCHITECT/DESIGNER'S NAME Last galk First �}ep4azt� Lic. No. U� ll%t
Architect/Dre` signer s Address Architect(Designerrs E-mail Address
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City> Wv� ' State F— Zip Rt s Telephone q cl- 2bZ-qG�2
ENGINEER'S NAME Last First F- Lic. No.—
Engineer's. Address Engineer's E-mail Address
City State �— Zip �— Telephoner
QOM 3NY , J C t Lic. No. 5867' _I ClassFB I
'- Contractor's Address . Contractor's E-mail Address
I S4D r-� W 4 �D 1 d :ICD`�t�.Ca p� i
City L FFGC�NN!�h( State eI I Zip C7o�� Telephone �q -'1 (�
SETBACKS REAR SETBACKS FRONT PERMIT NO. 4011-7 -0-731
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
DEVELb�FI1t5