HomeMy WebLinkAboutX2017-4049 - Permit Application�� rintFgtm Worksheet for Combo Building & Solar Permit Application
F- Comm'I j Residential City of Newport Beach - Building Division
T ME OF SUBMITTAL
NOTE. PLAN CHECK FEES DUE AT I
:Building r- Grading F-Drainage ZElec 1XMech Plum CuYdCut F CuvdFill F
Project Address (Not mailing address) F_ Flood r Fire j- Liq r Landslide F_N/A�Fl000rr Suite No
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Description of Work
1 j 6 K)1 C.tv Pdl� N ST" F�SVa-rM .%60;41 U'r/K
New/Add SFF Remodel SF 3q d Garage/New/Add I
OWNER'S NAME Last
First
Use �,FyConstType
rl
# StoriesFT6 # Units (if Res)F—
Va aerial/Labor J�
Material/Labor /
Owner's Address Owner's E-mail Address
City Z tz V jld ri _. _ State . -67.. Zip Telephone _q 4 Fj. .� - 2-4 t `
APPLICANT'S NAME Last
Applicant's Address
ell
City State C1'C Zip
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
First I
Applicant's E-mail Address
141
�j74� Telephone ���'L• -��''- Z�
First P,-','R L, Lic. No.
Architect/Designer's E-mail Address
y, �'• r �y F
City '�Ij l/tJj7� -r �3,r State C� Zip z L'Gt Telephone '
ENGINEER'S NAME Last First F Lic No.1—
Engineers Address Engineer's E-mail Address
City State I Zip F Telephoned
CONTRACTOR'S NAME/COMPANY
Contractors Address r0.Glt; L - L S
(� aVAUJI - a13
City A-) W f;6r�_ fge,,,Q, State —
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
..r�// (( ppbj���No. Class
i�Coin't�c'tors EI-mail Address I
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Zip Telephone ql q 5 ie"j)
PERMIT NO. - r(N I I � 'TU-("
PLAN CHECK NO.
PLAN CHECK FEES $ �O 1)LqCy