HomeMy WebLinkAboutX2017-1760 - Permit Applicationd YwYI §741,g
Worksheet for Combo Building &Solar Permit Application
E]Comm't it Residential City of Newport Beach - Building Division oNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
'Building F.1 Grading nage ❑Elec M ❑Plum Cu Yd Cut CuvdFill
Project Address (No mailing address) ❑ Flood ❑Fire ❑ Liq ❑Landslide ❑NSA Floor Suite No
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Description of Work
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Use I\35 Const Type FV8
k StoriesC #Units (if Res)
Valuation S
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OWNER'S NAME Last 12.21-7 i+i?First
Owner's Address Owner's E-mail Address /
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City , ! y _ StateL� , Zip H6 D Telephone "�Dq
APPLICANT'S NAMEI i
Last-jR-L.,� First ,�--vvli�`
Applicant's Address Applicant's E-mail Address
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City r State F-9 Zip 54-4 j Telephone %)' J?l 4-6 ^ l
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ARCHITECT/DESIGNER'S NAME Last y_/ rC t ^�I First �- rlLitil CJ Lic. No. 4�!
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ArchitecVDesigner's Address Architect/Designer's E-mail Address
City �� State � Zip M -� Telephone�,�'( �j�17'- �Z'�
ENGINEER'S NAME Last r ! first r li Lic. No.F --
�3LvEngineer's Address Engineer's E-mail Address E—D
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City State Zip Telephoned—,
CONTRACTOR'S NAME/COMPANYLic No. lass
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Contractor's Address Contractor's E-mail Address
City j State Zip Telephoned^
SETBACKS REAR SETBACKS FRONT PERMIT NO. r
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO s
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USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ L 7091 Ifo