HomeMy WebLinkAboutX2017-2052 - Permit Application-7 X366 �(�J1-�•
�� Worksheet for Combo Building & Solar Permit Application
Am' Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL :
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Project Address (Not mailing address C Flood ! - cuydFnl F
r Fire f Liq (- Landslide (N/A
76 1 5- rit (-141C(y t� Floor Suite No
Description of Work - --
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Use � ConstType �—
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Vo 0 ili ( l # Stories] 7 # Units (if Res)F
New/Add SF Z ��
Remodel SF J �} Garage/New/Add Valuation S I y C d
Material/tabor, `
OWNER'S NAME Last ll
First f
Owner's Address
S /144 C 1
3c a Owner's E-mail Address
city �.�(Si�/''z' State ! t?•f_
--- ZAP Telephone
APPLICANT'S NAME
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1Cd�L�� First
Applicant's Address
ZG p Z w C o / Applicant's E-mail Address
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city�t,
State fes----
- � ' Zip Telephanel`_�
ARCHITECT/DESIGNER'S NAME
Lastr------
ArchitecUDesigner's Address - - First Lic. No.
Architect/Designer's E-mail Address
city
State �- Zip
TelephonelF -
ENGINEER'S NAME
Lash
' First �--
Engineer's Address _. Lic No.
Engineer's E-mail Address
i
I
city
State I �—
' Zip ! Telephone, F !
CONTRACTOR'S NAME/COMPANy
Contractor's Address
i L' ( L -V) Lic. No. is Classy
Contractor's E-mail Address
C Z c1 �i bu c4�a7
city ; F --
• _ _ State _. Zip � �—
- - Telephone
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT -�- -�_ PERMIT NO.
SETBACKS RIGHT
l US€ -ZONE PLAN CHECK NO.