HomeMy WebLinkAboutX2018-1624 - Permit ApplicationX12,ov,87, -
Worksheet for Combo Building & Solar Permit Application
Comm'I ;Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
OSM,
`Building j Grading F -Drainage F_Elec y-Mech ]-Plum Cu Yd Cut cuvdRI
'Project Address (Not mailing address) C- Flood r Fire F.- Liq Landslide [N/A Floor Suite No
IIZ� l�lA S(�i�Gp. y fJP+\Y{�o9'or $PA%C,4
Description of Work
Use ! 5� Const Type
�.t-'f SRA'( IyfJS '�'e �XIS'�I IJG7 $A?ii
4Stories]2 4Units (if Res)i,
GA�IN�(^apt�� F�&1'� ��IOPONV
�l ►M F- oLA- (, 12 1 p-Afit. IW -1 %,YAL,t,.
Valuation $
New/Add SF) (:p Remodel SF Z$'j
Garage/New/Add I S
Material/Laborl -4(a� 000
OWNER'S NAME LastV- le. —�- _ __..
First, F13�NG`� 5 NL
_. C7
Owner's Address
Owner's E-mail Address
ISAN��{'P.KR.M.01�NlAIt..G'M
City. I . 4,v P®I=`( pi%aG. H _ .._ State
Zip j 4q % lcCs $ Telephone) cj
APPLICANTS NAME Last eo v eI �. � a
-_. .Firsts . p0 1,1 _.. _.
Applicant's Address
Applicant's E-mail Address
193o Pt6RDbl� �klte 2
dj\•tl���a�IA0PYN�00 60(w1
city r I,.OGj #,0CgS.1-•0tsP State 54�;,.-.._..
Zip800%5 TelephoneiSIC)-476-?,rii7
ARCHITECT/DESIGNER'S NAME Last 1 e�RC,
- �- First I P(t) N Lic. No. G 11141
ArchitecVDesigner's Address
Architect/Designees E-mail Address
l l��ao PLI•�17�4�. Ac�E�?i_
S\�lI�R.�ap�Ids.C�Y�fl�r�nM
City I:CJ� ficrlC� Er"l"" State Ga
Zip i 90c) Is TelephoneF, 10- 7q m X5 17
ENGINEER'S NAME-
Last's I _ I4b N(✓
- _ _—L---
Firsts -. Lic. No.
Engineer's Address
Engineer's E-mail Address
r
E
®>�
City i State �
i
Zip j Telephoner--
elephoneCONTRACTOR'S
CONTRACTOR'SNAME/COMPANY Lrj I L V a
&UH470:L 70: i 40 Lic. No. �� �Q� Class F6
Contractor's Address
Contractor's E-mail Address
Z; 3q2 ckNn.��RP�
r7 EaI 1 c.o�c r NE -I'
City:.l�- tl;100 �C> State
zip jgL('091-Telephone[4 8 5d�5
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $