HomeMy WebLinkAboutX2016-3198 - Permit Application�M- o�
Print Form Worksheet for Combo Building & Solar Permit Application
Comm'] ❑ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
�IBuilding ❑ Grading ❑Drainage ❑%tlec ech ❑. Plum Cuvdcut[---7 CUYdFill F_
ject Address (Not mailing address) ❑ Flood ❑ Fire ❑I Liq ❑ Landslide ❑N/A Floor Suite No
29 (OA( Ir -k VA a )rw cP 0
Description of Work
New/AddSF7- RemodelSFE:77771 Garage/New/Add
OWNER'S NAME Last
Owner's Address Own
City
State
Zip
First
E-mail Address
Use = ConstType F
# Stories❑ # Units (if Res)F7
Valuation $
Material/Labor
Telephone
APPLICANTS NAME Last cI�j5�ll irst
Applicant's Address Appt'sE-mail Address
City �\)V y6-ii.'. State I `-rt i Zip t`p'11 p„/na Telephone qj
ARCHITECT/DESIGNER'S NAME Last Rrghrnlp} First Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City a State Zip lephoney
ENGINEER'S NAME Last - or-\i`(3 First Lic. No. E�..[�.'� .
Engineer'sAddressAddress„�•11\1 Y
—�cio.Q
City
- rr .
CONTRACTOR'S NAME/COMPANY .O _,��aj1C1 i (11�Lic No. Class A �a�l
Contractor's Address Contractor's E-mail Address
City _ ��,�;� _ _ State ! Zip 'dcJ�.JJ.- Telephone q Vnq (0✓5�
SETBACKS REAR SETBACKS FRONT - PERMIT NO.via 7?1--j
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 2ti2.57 2D 1 iz
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
V2,0M, t 47,
Print For Worksheet for Combo Building & Solar Permit Application
Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building [Grading rDrainage lec _ ech F Plum CuvdcutF CuvdRI F
ject Address (Not mailing address) [Flood F7 Fire r Liq r Landslide rN/A Floor Suite No
2� F77 F_
New/Add SFRemodel SFF777— Garage/New/Add �—
OWNER'S NAME Last I [-{them mar a First
Use F—ConstType F_
# StoriesF # Units (if Res)F—
Valuation H I s/DQU
Material/Labor
bor -T�
Owner's Address
Owner's E-mail Address
wnatrko
--
City State Zip C•:� Telephone lil•� C.��
---=i— ------- --
APPLICANT'S NAME Last Rx-
Applicant's Address App nfsE-mail Address '/IS'1 S�l%nS U%�IcJS
City �rx,9'Xl _ _ - - State �— Zip ITC&A Telephone
ARCHITECT/DDESIGNER'SNAME SVIV
Last �- � 1,.� First F7561+ Lic No.�
Architect/Designer's Address
City State
Architect/Designer's E-mail Address
Zip l Telephone 55 45 1, 7{.
ENGINEER'S NAME l '
Last n`.C' �`� First Cx^ Lic No.Ff
Engineer's Address
City State (�
Engineer's E-mail Address
Zip -�IX4Q Telephone
CONTRACTOR'S NAME/COMPANY tic. No. <' Class V
Contractors Address Contractor's E-mail Address
�'•t� Ct1C�1�11rY1-�`vt�'�Il�`Cn. `c��C67.�i�.C,b'rt�
city '\J-- -_-_- _ -- State --� Zip �. Telephone
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO. \`��21t/• 7"Ici 2j
PLAN CHECK NO. 7 •. 2.L 1
q
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $