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X2019-1935 - Permit Application
�_C lit-1q7� Print Form Worksheet for Combo Building & Solar Permit Applicationou F- Comm'I F- Residential City of Newport Beach - Building Division N(�TH� PLAN CHECK FEES DUE AT TIME OF SUBMITTAL F -Building F_Grading F-Drainag )Elc r-Mech F- Plum Cu Yd cutF— Cu Vd FlllF_ Project Address (Not mailing dress) F_ Flood r Fire r Liq r Landslide F_N/A Floor Suite No Description of Work Use F_ Const Type F_ #Stories # Units (if Res)F_ Valuation ry) C O0New/Add Material/Laabor(�V V tt r ,Ay4t\ -�-4C' 'sp'; - C5'� iY>c�tU,ciu�\ 61 CAnty, leA4e'Y Sty n \V1 V,r ,grc'I'C4 Fes- SF Remodel SF Garage/New/Add F OWNER'S NAME Last l '�IC)r� 44 First 46,yV_ Owners Address Owner's E-mail Address 13 vVe�ri"04+- m*jY-\l (L yidia cc, City �K,$ 90Y '�j eQ O State , } Zip q 466 Telephone G ((� . &f T APPLICANT'S NAMEp Last l First igJq.S Applicant's Address Applicant's E-mail Address y Cty 5` Jra s a �at�ro cel City c Lt tl1 V l �Y1. r� iv\ rj State C /r} Zip q 2� V 1) Telephone q�}/27wl &,C3,7 ARCHITECT/DESIGNER'S NAME Last FirstF_ Lic. No. Architect/Designer's Address Architect/Designer's E-mail Address city State �- Zip F Telephone[ ENGINEER'S NAME La t•.. V VV First Lic, No.[ Engineer's Address Engineer' E all Address City � State I Zip F_ Telephone— CONTRACTOR'S NAME/COMPANY C ®' e6 `( Lic. No. , C 1,3/o2 Class c "Y5 �l Contractor's Address Contractor's E-mail Address City �� Y�(ly� State Zip q2,:fT0 TelePhon©off Zit, 4Cti•7-7 SETBACKS REAR SETBACKS FRONT PERMIT N0. )V& ''s SETBACKS LEFT SETBACKS RIGHT gg PLAN CHECK NO. (rl USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ V t V