HomeMy WebLinkAboutX2018-2063 - Permit Applicationorm X 9017
Worksheet for Combo Building & Solar Permit Application
�_� Cit of Newport Beach - Building Division
6mm'I lyl,ttesidential y p 9
�v NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-IBuilding F-1Gradingj-Drainage
rJElec r1Mech f-IPlum Cu rdCut l l Cu Yd FillF-1
Project Address (Not mailing address) rl flood n fire f -I Liq n Landslide [N/AI FlSuite No
Floor
3 V I�
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Description of Work
Use n Const Type n
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N Stories #Units (if Res)[
/ I
44- rfze.zcIs rtit,+o C�GSr� s sewe+�
Valuation $
Material/LaborFSb/��97
New/Add SF
Remodel Remodel SFF—I Garage/New/Add
OWNER'S NAME
Last First
Owner's Address
Owner's E-mail Address
City
i State F Zip r_ Telephoned
APPLICANT'S NAME
Last ( �VD --- First r U kN
Applicant's Address Applicant's E-mail Address
-S 2 �- Tieume 477 T -C t? np. STE t Iaodcea
vo . u3
City .J-QVI/UE
q 7 q
State C-"- I Zip fG- 6 �G� Telephone 4_q 27g L. _. q o
ARCHITECT/DESIGNER'S NAME
Last First F— Lic No.
AichitecUDesigner's Address
Architect/Designer's E-mail Address
City
i
,State F— Zip F_ TalephoneF—I
ENGINEER'S NAME
Last -�' First Lic. No.�—J
Engineer's Address
Vv 0c w� U, " 9 7S
Engineer's E-mail Address
,14pG 4 S i -H TE PoAo, Pa 9,?( 2 a_4g J ui � yai) 4 r% -. c cc'm
City f�f}kERS'16L(�
(-
_ I State C7`}-._.. ZIP /�.C'73I Telephone ��i�-S.SQI- 8 Zo�j
CONTRACTOR'SNAM�{E/COMPANY Lic. No.
F-1 1 CllassF-1
Contractor's Address V
�^
rUr ; - Contractor's E-mail Address V �' o
City
State Zip Telephone
SETBACKS REAR
/
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NOPLAN CHECK FEES 78 -J(]
D2_61 Z - nq/I