HomeMy WebLinkAboutX2013-1375 - Permit ApplicationWorksheet for Combo Building &Solar Permit Application 941
r Comm'I i Residential City of Newport Beach - Building Division 1�pi3 0Z]J�p
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM�TTAL
wilding r— Grading r'Drainage r Elec WC
ch r Plum CuvdCutF curdrili F
Project Address (Not mailing addressod r Fire f Liq ( Landslide ( N/A Floor Suite No
Desccriiption of Work / / Use F—ConstType F_
A!eIo lr Dj l�b'II;w1p� , dStories� /4Units(ifRes)�
�� Valuation$ V &0
New/Add SFr-- Remodel SFr— GaragedVeva/Addy-- AriluatlllLabor too
OWNER'S NAME Last S�1"Lyv10nljt7nf First
Owner's Address Owner's E-mail Address ✓ •3
PRO SoLlm d�� ,ryvwf /
City i�,.� (hCr / State _C� Zip F? ��,rjZ Telephone
APPLICANT'S NAME Last fflCC,,ANum� First
Applicant's Address J Applicant's E-mail Address
I,� UIStACr�li'hus _I nicaieoeaallou-
City iLvc lol . of A Aidt State L'F` Zip . /W (PU Telephone JC_,, ,Qs(,
ARCHITECT/DESIGNER'S NAME Last 1,J5 4 E B E4 First /`-Lic. No, r—
Architect/Designer's Address Archftect/Designer's E-mail Address
city I {V �wlaor+ ISfq_I State C,�-- Zip ��( 3 Telephone qy�q ��3
ENGINEER'SNAME Last L,Jer _ First _P_F/ _ L1cNo.-12
Engineer's Address Engineer's E-mail Address ✓�y.3D { L4
City rcLc 0.LC tChc� State I C Zip 911 017 Telephone '�Jy % 3cj! �S
CONTRACTOR'S NAME/COMPANY Lic No.F OassF
Contractor's Address Contractor's E-mail Address
City State F Zip F Telephoned.
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $