HomeMy WebLinkAboutX2017-3281 - Permit ApplicationPrint Forn Worksheet for Combo Building & Solar Permit Application
F_ Comm'] F- Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(Building F- Grading I -Drainage �Elec F/_'4ech A Plum Cu Yd CutF Cu Yd Fill F_
Project Address (Not mailing address) F- Flood F_ Fire r Liq F- Landslide FN/A Floor Suite No
P_ �k t494 7—
'
Description of Wor
Use�p ConstType Gl"Fi�
#Stories #Units (if Res)
d IJ - it(✓ gkL., Y) - R'4r-ffiq I W IX -
I r
Valuation $
Material/Labor
�
New/Add SFF— Remodel SF S � Garage/New/Add —
OWNER'S NAME Last = t� s First
Owner's Address Owner's E-mail Address
l LL_ ► N)A/0 Pi?
City _ Zr- (ri/✓F _ _ State F7 Zip �� L.;L'I `7 Telephone .! Tj
APPLICANT'S NAME Last _. �._.... _ _. _. First
Applicant's Address Applicant's E-mail Address
City �/ � � State L• Zip "2`ii.� � Telephone 277_�-1 - ?i .�,v
ARCHITECT/DESIGNER'S NAME Last f >F p First N 1 9 _(q-
(Z�G C�J7 ��� Lic. No. � I l i/
Architect/Designer's
Architect/Designer's Address Architect/Designer's E-mail Address
City '�r�b1/j7`r2� �jr�Ci ( State ` Zip , %/G" "'l/ Telephone I .`I �- p Lj
j
ENGINEER'S NAME Last First F—' Lic. No.F_.
Engineer's Address Engineer's E-mail Address
City _ State F_ Zip F_, TelePhoneF—
CONTRACTOR'S NAME/COMPANY pay
y i /1 Si r t 1p Y - Cofjfj tyk� is No. '%� Class
�`1 ,•!
Contractor's Address Contractor's E-mail Address
gs�r�e�►)c
City 1 Qv' I V& State I L�p�- Zip Telephone' (?-I '.
t v
SETBACKS REAR SETBACKS FRONT PERMIT NO. ,� J V
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 6 K4 t
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
33ZId
�,Cv