HomeMy WebLinkAboutX2016-0084 - Permit ApplicationY'
CrintForm Worksheet for Combo Building & olar Permit Application�Run Comm'I Residential City of Newport Beach - Building Division X20IG - Q084
NOTE: PLAN CHECK FEES DUE AT TIMEOFSUBMITTAL 01.)55 -2016
Buildin
�� g Grading (.._Drainage Elec. Mech ` Plum co Yd curl Cu dFlll' —
Project Address (Not mailing address) Flood
i Fire Lict Landslide A Floor Suite No
i r
opoPwA Till a
T P5, Ef•G+i GG.
Description of Work
Use 72 Const Type jV_6
J
r — - -.t--------_fit---
-----
PDD it'10/V 0T i224J V�_ 58
k Stories q Units (if Res)[
Valuation $ n/ p�-
Material/Labor
New/Add SF[_ 8, Remodel SF)
Garage/New/Add
OWNER'S NAME Last! MAF -5+4
First I—cl X I c>
Owner's Address
N(4SC�or� DR• New��R I15+saGH
Owner's E-mail Address
City N Wppq,-tF {i State i
Telephone[ ----
gg1 375_ W7'5
APPLICANT'S NAME Last"
First lstu rt -
Applicant's Address
Applicant's E-mail Address
44, lam
��,�t-®� 4fr� •� -
City GpL�-f-A M�<� State j („d
Zip Telephonelcj Lt�q4-65lj
ARCHITECT/DESIGNER'S NAME Last —INA, -
First ��l(Q
.`�IC.�A�� Lic. No.
A,;hitect/Designer's Address -
...-.___ _ _-
Architect/Designer's E-mail Address
�1�I �i�t 11 AY�t•4u�
1 �G��?.R��CQ� •GcyY"�
City �AMge, State
Zip lgy�zt� Telephonegf{G, yyN -83,815-
ENGINEER'S NAME Last
First Se: i'T Lic. No.6y1jq 7
Engineers Address
Engineer's E-mail Address
?�tiIEN'►'�P-� S�rf'6 ??��
v�/fy1G+i1'EHW N�R-S•tor'�l
City l�b�/�NFi - State j 6#4,
Zip lZI�0(& Telephone��fj�
CONTRACTOR'S NAME/COMPANY —
I �l AZT �J�J
Q` c No. � Class if am
c. 1 � �%lD%?GYM j =
�_GY( Li
Contractor's Address
Contractor's E-mail Address
+ A lticA +: cam,
City �'-,t tI j C�M�� Slate G/�
v' tRE^AtR
n -e -
Zip j � '7 l� Telephonej�t.� �J-���`�§��
U VV
SETBA SETBACKS FRONT �� PERMIT NO.
BACKS LEFT _2 t SETBACKS RIGHT 62 f _ PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES S
N