HomeMy WebLinkAboutX2015-3098 - Permit Application (2)Print Form�jj'IIir�lorksheet for Combo Building & Solar Permit Application(114911
Comm'I r ReSidenfi � City of Newport Beach -Building Division 3Ll� VJ��NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r,Building r– Grading rDrainage r,Elec r, Mech r– Plum Cu Yd Cut Cu Yd Fill
Project Address (Not irr i g address) r! Flood r Fire r Liq r Landslide rN/A Floor Suite No
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Description of Work
Use F Const Type
# Stories'; # Units (if Res)',
Valuation
Material/LaaborFy f j%
New/Add SF�, Remodel SF�Garage/New/Add �',
OWNER'S NAME Last I600_ C�JLO�O 74,( C First
Owner's Address Owner's E-mail Address
3:?1 a N�wPo/1 �PC .ru�ncio4
City VE 00/7o i'9��77 / acw .. _ State c Zip uZZ? Telephoned _.. .
APPLICANT'S NAME Last /a(UM/h[. yL /�/C First
Applicant's Address Applicant's E-mail Address
City 2rVafloo� _.. State Zip �('LJ7J�. TelephonegJ–(–�j,�–��(Dr
ARCHITECT/DESIGNER'S NAME Last fv&O &_/i First F I Lic.No.r—';
Architect/Designer's Address Architect/Designer's E-mail Address
3`l3�4 C1✓�A'r. V/,Cl-r oz
cityt/" L. �r/fu _ State Com , Zip q'OL 4. J— ..Telephone 3/ Q
ENGINEER'S NAME Last 67k/First Lic.No. ��'--
Engineer's Address Engineer's E-mail Address
/7J o 140,91a
City L%LV�NQr State Cg Zip �ZG/Y Telephone Y(�-ZJ27y/J?U
CONTRACTOR'S NAME/COMPANY f New UT Lic. No. 71011-02 Class'.
Contractor's Address Contractor's E-mail Address
su /'l4u'ld,t,, Ota_
City/J df "V A) State !. Zip Q L (i ij._. , Telephone � � 7 ., (� Z LiGYJO .. .
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
1/ 111�,. IA 1 15' 1 V !. I