HomeMy WebLinkAboutX2016-2326 - Permit ApplicationWorksheet for Combo Building ol�t Application
❑ Comm'I ❑ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAI
❑Building ❑Grading ❑Drainage ❑Elec ❑Mech ❑Plum CuvdCut l CuvdFill � -
-71
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
2 2- 2 E71 0
Description of Work Use ConstType 17
D
# Stories❑ # Units (if Res)❑
'=�--�-- Valuation $ ��
New/Add SF Remodel SF Garage/New/Add Material/Labor /1�
J
OWNER'S NAME Last ftC First 1GV44L aC--/
Owner's Address Owner's E-mail Address
City State ® zip L�—I Telephone %
APPLICANT'S NAME Last {�C q First -Tf M', C
Applicant's Address Applicant's E-mail Address
1 u� IE
I fA-C*, G-rnvtl`L . owl
City �(,g. State Zip RT.�4_0 Telephone
ARCHITECT/DESIGNER'S NAME Last '
First ,(-(,, Z0,l Lic. No. (� %
Arch itect/Designer's Address Architect/Designer's E-mail Address
('L ` P�hr �(}4(rtFl—C�lsi.g�cs�t{'tE.co
City 't/qq- (g-e _ State �,- Zip �2� Telephone 1 / ^ ( ZO
ENGINEER'S NAME Last /r(rIt't First Ctf't&l) Lic. No.
Engineer's Address Engineer's E-mail Address
r
"emtM � 6-r1-1�—Fo!/iYi'iI.C�lGi C9
City State I LG>, Zip �'LI(/�� Telephone j�-�%'L0
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CONTRACTOR'S NAME/COMPANY /6Ylllr � G,� Lic. No. ffq s � ?, Class
VY� �CVo"otractor's
Contractor's Address El Address
W1
City G .O , �(, State Zip "b y� Tel phone _ 'y -7
SETBACKS REAR SETBACKS FRONT PERMIT NO. J �Q-Ti7-1/
SETBACKS LEFT _ SETBACKS RIGHT PLAN CHECK NO. 1 S1 D • I U6
USE ZONE DEVELOPMENT NO_LaIQ l7%j �� PLAN CHECK FEES $