HomeMy WebLinkAboutX2014-2922 - Permit Application�/,7-o I W -ZP( ?,?-
Worksheet
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Worksheet for Combo Building & Solar Permit Application
Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Description of Work
Y
Yd CutI _ Cu Yd Fill
FLandslide F__N/A Floor Suite No
Use ConstType f
# Stories[, # Units (if Res)F7
i
Valuation $ Fi3
New/Add SF� Remodel SF� Garage/New/Add r- i Material/Labor Q
OWNER'S NAME Last I /�� f First I J f iy-) or')
Owner's Address Owner's E-mail Address
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City New 2r -l. State [—CP-1 Zip FI Telephone %A,
APPLICANT'S NAME LastuG na,Sso v� First
Applicant's Address Applicant's E-mail Address
City__,_ FWs J State C) /_ Zip Telephone-. % `,490-_�j3to
ARCHITECT/DESIGNER'S NAME LastI First 7 Lic. No. F7777777
Architect/Designer's Address Architect/Designer's E-mail Address 2Z 1 Lf -2,11 22
-- 1 F 4
City 1 State F Zip FI Telephone _ _)(_ ' N 4-2 j
ENGINEER'S NAME Last First- Lic. No.
Engineer's Address Engineer's E-mail Address
City I State F_7 Zip I Telephone -
CONTRACTOR'S NAME/COMPANY CQCLp i / J� Q (, I Lic. No. SFop%V lass
Contractor's Address �2 Contractor's E-mail Address
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City 5� State cr7 Zip ��:o�� Telephone
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $