HomeMy WebLinkAboutX2017-2161 - Permit Application2 oZ2,a1 O
Worksheet for Combo Bui Ilcation oFY;
Comm'[ Residential
City of Newport Beach - Building Division ('
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding I— Grading F-Drainage `lec F �Mech
r lum Cu rd cutF Cu Yd Fill
Project Address (Not mailing address) C Flood
j _ Fire xLiq j_ Landslide F_N/A Floor Suite No
Description of Work
Use ConstType �—
# Stories # Units (if Res)s
AE4,o,0 c— v- fly 01 TaAj
9x� Ba z-
Valuation $ GS p 000
Material/Labor
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New/Add SF � Remodel SF I -� / �F Garage/New/Add F J'AME
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OWNER'S NAME Last /Q0,4 Cry
First= B)94:0 'F-
Owner's Address
Owners E-mail Address `/ ytEW O �i�eD. GpW1
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City _. ifs ® _ p State
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Zip I 0 Telephone q4q 233_ yj-y�-
APPLIC[A_NT'S NAME Last' ^ ^
First l J�fO7_
Applicants Address
Applicants E-mail Address
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City State ! C,_j--
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Zip _r2 a Telephone) T 6 9 — P77 7
ARCHITECT/DESIGNER'S NAME Last'; J ��
First Li/c No.
{Architect/Designer's Address +'r 'a(j ✓,
Architect/Designer's E-mail Address _
City t State
Zip F— TelephoneF—
ENGINEER'S NAME Last',/�J�-T/
First ���. LicNo.--;C_O�b�O
Engineer's Address
Engineer's E-mail Address
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I C/nxe-,(?, Co)<'.het
City G ,a,/ jN/� State
Zip 92 6 S'!o Telephone. q y�
CONTRACTOR'S NAME/COMPANY — - ��\ y Q� A Lic. No. 16 3CO Class,,
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C
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Contractors Address
Contractor's E-mail Address
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City! State _. -_
I C. ��4 /
ZlpIgz6 Telephone7
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SETBACKS REAR C7 / SETBACKS FRONT
PERMIT NO. ',0,0 1-7 �1
SETBACKS LEFT SETBACKS RIGHT
4 PLAN CHECK NO- 2O t
USEZONE... DEVELOPMENT 1J0
PLAN CHECK FEES $....