HomeMy WebLinkAboutX2017-0614 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application 6�E'"'°re
F- Comm'I [K Residential City of Newport Beach - Building Division y
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL c.��on.'
Kuilding j- Grading F-Drainage r Elec F- Mech F- Plum CuvdCut CuvdFill
Project Address (Not mailing address) I— Flood r Fire F Liq r Landslide N/A Floor Suite No
(001-'153 �c ow.ov.�oc �c t,J2 CIA tf
Description of Work
Use F—ConstType F_
# Stories # Units (if Res)r
Valuati
New/Add SFF Remodel SF� Garage/New/Add �
Laon a t3 t S o0
Material/bor
PIP OWNER'S NAME Last V\c First I !3'qtC,3
J
Owner's Address Owners E-mail Address
3`kft 1 �,j %a- So.
—
City NAC_cvv eLJ, State Cf ps Zip q Telephone "L45 -3(7p
PPLICANT'S NAME Last I r Frst O LL LL_,
(� /
Applicant's Address Applicant's E-mail Address�nat45�
5-SO ti1�w�oc� Cep r �c
City \, ew joc�r `��e.�tt.. State Gl� Zip 7Z"o Telephoner
ARCHITECT/DESIGNER'S NAME Last First i I
Lic. No.
Architect/Designers Address Architect/Designer's E-mail Address
City I State �— Zip [ Telephone[
ENGINEER'S NAME Last C\,, r-`SS( `0.v, First M Lic. No. 5, bt71705
Engineers Address Engineers E-mail Address
VIuy W + K��e1\�. (�,,� lj�._Wj
City 0�, State F�- Zip q'67 Telephone
CONTRACTOR'S NAME/COMPANY V, 2 en.. t) v\. Lic. No. I $�}qly Z Classr
Contractor's Address Contractors E-mail Address
3yYol \'ta. Go- -SVo`v.
City State GW Zip q2 (p 2-1 Telephone ��1 37O o3453
SETBACKS REAR SETBACKS FRONT PERMIT NO. (N al� _ up 1 q,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. OqH -
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
(5t3- /�Ib/xZoib-Iga3. 4Ksw/Wr