HomeMy WebLinkAboutX2014-3556 - Permit Applicationo�iWPog6 i
Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
F-I Comm" 7-Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-4uilding [-I Grading F_iDrainage rLElec F-!Mech rPlum cuvdcutF cuYdFill
Flood Fire Li Landslide -NIA Floor Suite No
Project Address (Not mailing address) [J ❑ g ----i
Description of Work Use Const Type
tom,( paptr t �py�r Sett )N� # StoriesF1 # Units (if Res)[7
vJ � Valuation $
New/Add SF C Garage/New/Add I( — I Material/Labor I
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OWNER'S NAME Last ���jp�LC _ _ First I7�
Owner's Address Owner's E-mail Address-
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City Nr [r C7�'1T r/ S—J State C E7 Zip - Ts
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APPLICANT'SNAME Last
Applicant's Address Applicant's E-mail Address
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2 City State �] Zip S k Telephone �{ , �? (�p�
ARCHITt E9— NER'SN� `AM Last —c — First J LicNo. Cl�ilE�i
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d Architect/Designer'sAddress Architect/Designer's E-mail Address
State P _ Zip i�5_(- Telephoned
city _--
ENGINEER'S NAME Last t n,( First N� — Lic. No. 4C1sj ? %
Engineer's Address Engineer's E-mail Address
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city --d,�iU-�. _J. State Zip � �`{�J�J. Telephone f>i
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CONTRACTOR'S NAME/COMPANY J Lic. No. Class
Contractor's Address Contractor's E-mail Address
---------- --� State ZP.�J Telephoner—.—�
city —
�ETBACKS REAR ('b ( SETBACKS FRONT
SETBACKS LEFT t' SETBACKS RIGHT
-USE ZONE` �sr �j (!a 0 DEVELOPMENT NO
PERMIT NO. 1-1'0`
PLAN CHECK NO.
a
PLAN CHECK FEES $
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