HomeMy WebLinkAboutX2018-0219 - Permit ApplicationII I Mzry�AaA4Z}C2nl � - 0211
Worksheet for Combo Building & Solar Permit Application o��E��
City of Newport Beach - Building Division 0 1L��
omm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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building Grading �prainage �Elec ech lum CuYdCut "�"`' CuYdFill !
/Project Address (Not mailing address) I— Flood Fire Liq Landslide [_N/A Floor Suite No
Description of Work Use i ConstType 'IV
# Stories, # Units (if Res),
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Valuation $
New/Add SF Remodel SF Garage/New/Add Material/Labor' tsl�/vjW�
OWNER'S NAME Last I .+Ij ���s( 21 First
Owner's Address Owner's E-mail Address
City U� State �f Zip +� Z Telephone;
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APPLICANT'S NAME Last < First
Applicant's Address Applicant's E-mail Address
t'Cd �� ( ��, �- -j�i/ �1, �, . a FLA e C` caw.
CityState c! �, L Zip I( Telephone���
ARCHITECT/ ESIGNER'S NAME i
Last S �,r" - 1t✓First, Lic. No. o
Architect/Designer's Address Architect/Designer's E-mail Address
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City ; State Zip 6 Telephoned® v`��
IENGINEER'S NAME Last i — Firs ' ic. No.
Engineer's Address Engineer's E-mail Address
City # 7 ��� State ' Zip 7 f,,, ° Telephone l� `"�) � ` `�'2'�
CONTRACTOR'S NAME/COMPANY ? f �� Lic. Na 1 Class
Contractor's Address �/V Contractor's E-mail Address
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City 11 � State ( Zip Z Telephone' q y
SETBACKS REAR / SETBACKS FRONT PERMIT NO. o - C7 -7,v(
SETBACKS LEFT ® SETBACKS RIGHT �� I J PLAN CHECK NO.
USE ZONE W -- MA& DEVELOPMENT NOi 2Z42 &
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