HomeMy WebLinkAboutX2018-3004 - Permit ApplicationPrint Form Worksheet for Combo Building &Solar Per �1� �DR>
g Permit Application
�; Comm'I Residential
City of Newport Beach - Building Division g
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL C9[iFOANP
r_�Building [`1 Grading f--Drainage rj Elec f—� Mech [—I Plum Cu Yd Cut �l Cu Yd Fill
[ I
Project Address (Not mailing address) I -] Flood r) Fire f J Liq Fj Landslide F-IN/A Floor Suite No
F F-7 F-1
Description of Work ) Use Const Type I
# StoriesFT # Units (if Res)F_
SFC�-
_ Valuation $ 1
New/Add SF Remodel SF Garage/New/Add
Material/Labor 32S C) ®®
OWNER'S NAME Last 'D�.� I First I L- I N is 1
Owner's Address Owner's E-mail Address
1S Mi�c. t2-t►� nay dtt-rWg@ `o-600, com
Cj State CA Zip G
City 12U'L? Telephone
APPLICANT'S NAME Last P(�uC � First aLL_
Applicant's Address Applicant's E-mail Address
21.3O C-.. GAV-E9- ado 410,ux he G 'cckmer .c-dr^
City I boom Mesa State 0_1z4z6 I Zip I C.At, j Telephone -714-446.19635-
ARCHITECT/DESIGNER'S NAME
Last /V`VJ CO(ZQ. First �2l r a Lic. No.
l
Architect/Designer's Address Architect/Designer's E-mail Address
5t� t taus (JR• 'D2�o trl�or�@ MwAeor ,C
City c; e,,rA Ni1ESA State �, l Zip Telephone C,SA-2q3 �i17(Q
ENGINEER'S NAME
Last I
First I
Lic. No.
Engineer's Address
Engineer's E-mail Address
City I I State �— Zip—J Telephone
CONTRACTOR'S NAME/COMPANY DM
Lic. No. 53(5$'72 Class
Contractor's Address Contractor's E-mail Address
25b G•S�dG6C�• �`'3no _ _I t�lela.t�c�1G @�d�rr9�,cot...
City NSvA, SA State 0,A I Zip OJ-Z zCo Telephone 7f4.5,1..(.At-�v
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $