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HomeMy WebLinkAboutX2018-1378 - Permit ApplicationCIA Print Form Worksheet for Combo Building & Solar Permit Application o4'',cPo"a r Comm'I r Residential City of Newport Beach - Building Division NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL FiBuilding f-Grading. rDrainage F'Elec �!Mech F-, Plum Cu vd CutF �l Cu Yd Fill �I Project Address (Not mailing address) FI Flood F- Fire n Liq F''� Landslide F7,N/A Floor Suite No �0Lt #AZ6 L, �� COMA/✓/} po-�_ 104d F Description of Work Use F— ConstType I', LLISVtkj-T� c fidl 4 L irlT/p ✓ t1/�LL #StonesF_ii kUnits(ifRes)F Ta A DO 6 fs0lwo *rl Valuation a o O b Material/LaborF�/ New/AddSFF_0 Remodel SF Garage/New/Add �I r OWNER'S NAME Last V�i IN First E{- Aq /- Owner's Address Owner's E-mail Address 0 $U Pi ya) L 1 City I /,'tu rOitr I�UAi/l �,, State C/} Zip Telephone ?/0' YC3 ay74/ APPLICANT'S NAME Last S�} /f f�� First', Applicant's Address Applicant's E-mail Address City State F �', Zip F Telephoned ARCHITECT/DESIGNER'S NAME Last Odpa (�1zcH First —I Lic. No. . Architect/Designer's Address Architect/Designer's E-mail Address 00 tz erg YtC_L 14 vtf !t/t=J o/ �P414'J0 AIt6 7-Ct75. tcl 1 City Cos i /� lv[ p'� A- State F/ �'1 Zip �� t„ �i Telephone �� 7S-y yO40i ENGINEER'S NAME Last C /ry/Gatlt/ t/ c7 First Lic. No. F_ Engineer's Address Engineer's E-mail Address 23 7z L<} F /2 /IJr' Co/Gtss� evcr�rLc%, cazr jL��A City �f�G)UtJ/.>. 91(Lt,S State C,� ZIP �?1G�7 'i, Telephone�'fyLj �5y7�r�4 CONTRACTOR'S NAME/COMPANY 6 wr✓ LD!/Yl Lic. No. F Class Contractor's Address Contractor's E-mail Address City State F_'� Zip F_ Telephone'', REAR SETBACKS FRONT 4P MIT NO. LETBA LEFT SETBACKS RIGHT PLAN CHECK NO. DEVELOPMENT NO PLAN CHECK FEES $ k20)9 -1315 Workslheet for Combo Building & Solar Permit Application (FI,-ml yComm'IResidential City of Newport Beach - Building Division (VOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c<•Fow^ Xuilding Grading jfjDrainage i—Elec rMech j Plum Cu vd cut Cu Yd Fill Project Address (Not mailing address) i Flood F Fire r Liq F_ Landslide F_N/A Floor Suite No F r 15011 M ZE\- `PZ. r LmooAoft_ MAZ 6A . 9 3lo a to _ Description of Work Use I� I Const Type �,� # Stories, #Units (if Res): ' AVD1,100 &F 10 - -0 F-)c16tl N6 ALSO WK0U _ cK- T 9te:Rt0RS *f-y'tf-'R�oRS Valuation $ Material/Labor; 3,50/000 New/Add SF 1� Remodel SF �( (,v Garage/New/Add �— OWNER'S NAME Last j�04- RAZEL- �)QW L-L-b. First Owner's Address Owner's E-mail Address City', LO{pjjAgAA /1 State Zip Telephoned APPLICANT'S NAME Last, I_I NJ li� First ,b'RAO D DyJ Applicant's Address Applicant's E-mail Address �G1��'S.Cp� City � � M State Zip i �a Telephone 1�� YO ARCHITECT/DESIGNER'S NAME Last U A ftO 11F A rWJ,'F5 First j Lic. No. Architect/Designers Address Architect/Designers E-mail Address • �j� M� I City -. State Zip i TelephoneF ENGINEER'S NAME Last '©�'N MI First; A 1 Lic. No. Engineers Addresss11 Engineers E-mail Address 9�1� W, City ll-AGUNP� State G� Zip'qQL�65Telephone!�lt} aLti i CONTRACTOR'S NAME/COMPANY Lic. No. Class' Contractor's Address Contractors E-mail Address City ; State Zip Telephone; } SETBACKS REAR SETBACKS FRONT PERMIT NO.�� { • �J' SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. USE ZONE DEVELOPMENT NO VLAN cHEI-- K FEES a