HomeMy WebLinkAboutX2019-0419 - Permit ApplicationPril
nt Fo�nl Worksheet o Combo Building & Solar Permit Application
Comm'l r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building r Grading Drainagelec rMech Plum cuvdCut l cuvdFill
'roject Address (Not mailing address) F Flood r Fire I— Liq r Landslide FIiN/A Floor Suite No
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q6?0 IV45_4��2W'?Tc:fefll-elZ n/ -L I F F-1
of Work �' / s6:0 A
d 4�N -C V W Yid l Use F—Const Type
,�v�cQ,2n - I
—� ' # Stories': # Units (if Res)!
Valuation $
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New/Add SF Remodel SF Garage/New/Add a/New/Add Material/Labor
OWNER'S NAME Last
Owner's Adddrresss,,
City pr r� .j/%. .._ _.i State /40
APPLICANT'S NAME Last
Applicant's Address
/rte¢/ /ZZJ</ 15i'/ S1611_z4y
Cityo,,5 /� ,A✓!e't7w State C'/4- 1
I
First
Owner's E-mail Address
Zip VON/17, i Telephoners
First
Applicant's E-mail Address
�r,�ii�C~Jes�if�l�re , corv� �
i
Zip... �Z,E �.-� Telephone
ARCHITECT/DESIGNER'S NAME Last rf � ��ce �!l� First F Lic. No �0/5_51
Architect/Designees Address Architect/Designees E-mail Address
City StateF Zip F Telephoned...
ENGINEER'S NAME Last �I First Lic. NoT
Engineer's Address
City State r_
Engineer's E-mail Address
I
Zip Telephoned
—
CONTRACTOR'S NAME/COMPANY Lic. No.bowClass
Contractor's Address
a$® 1 Eiax4q biz _ -5� 3 0t-
City p 56arC,� State I v�
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
=MIM @ nk)iU
Zip . lQP 7r7 Telephone 310.. 371/... 7sa
PERMIT NO. XIM - 04-11
PLAN CHECK NO. Dsrozy) I
PLAN CHECK FEES $
Ll Li 15 9 76b