HomeMy WebLinkAboutPV2019-110 - Permit ApplicationA/vzotOt -ttu
Print Form Worksheet for Combo Building & Solar Permit Application
Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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F -Building Grading
F -Drainage f-Elec rMech F- Plum CuvdCut Cu yd Fin s`
Project Address (Not mailing address) F= Flood r Fire C" Liq r- Landslide FN/A Floor Suite No
Description of Work
Use F— Const Type
# Stories # Units (if Res) [">
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Valuation $ /V
Material/Labor
New/Add SFF_
Remodel SF Garage/New/Add r
%7 -
OWNER'S NAME
Last I MAce, iaN TE First W _-v,0y /mj/ftY/RO9trT
Owner's Address
Owner's E-mail Address
Z 1 C 1 ii TSTA nit2Ala
City
1,
State Zip F c j _.-___.- Telephone Ci'
j7.r./-. ' Z%.C�.. �3%-7 .
APPLICANT'S NAME
Last -7S7, -,e) FirstipU/i/eL
Applicant's Address
Applicant's E-mail Address
332-7-GHj { r ru
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1pINOZcitr,, Fff Cc!"mof Yul%. �..lj.Y'I
City I 1200+t -- ce_
State i✓W Zip gcog6 Telephone zt_�
ARCHITECT/DESIGNER'S NAME LastFirst F Lic. No. F
ArchitecUDesigner's Address
Architect/Designer's E-mail Address
City
State F_ Zip F— TelephoneF_
ENGINEER'S NAME
Last � First [--- Lic. Nof
Engineer's Address
Engineer's E-mail Address
city
State (-.-- Zip F---- Telephone—
CONTRACTOR'S NAME/COMPANY
IF Lic. No. li}Z=i(� i ( Class �-cio
Contractor's Address
Contractor's E-mail Address
33;z
'Lc, Com) t^reC-dovk Fare,,C-4', CJ J,'
City l C br'1Vs�f f C t
State Zip f(jo Telephone Z{'3 ` is t- zz 4
SETBACKS REAR
SETBACKS FRONT PERMIT NO. T\&(1 . I IV
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $