HomeMy WebLinkAboutX2019-3604 - Permit Application2N�5-
l?rint FormWorksheet for Combo Building & Solar Permit Application
F Comm'[ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j(Build[ng r, Grading F -Drainage FElec r- Mech r Plum Cu Yd Cut F__ Cu Yd Fill l
Project Address (Not mailing address) F_. Flood F- Fire r Liq r Landslide r_N/A Floor Suite No
113q I/z W, FaAL P70A 6L -up
10,9 �4 W(K_ /)�_
Description of Work
Use F— Const Type I
# t 'es[ # Un[ts (if Res)f
I�EpAIR o� W�'iClz bAMAGrct7 GO �'
f m y�
✓i`y - OUVY
-
Valuation $
t�(atcy al/Labor Y 17 / QO
New/Add SF,u � Remodel SF /Q Q 0
Garage/Ne b
OWNER'S NAME Last I Bvyv*�/
First FR6(TT F,
Owner's Address
12-0 rUST IN aYS'-1s-CE\C�
Owner's E-mail Address
dcL6"1orP-ya.boc.cotrt
City I N a tNr0 j4T 15SAC n State F47A
ZiP ti�zc, i Telephone CJ' ICJ 7& 4 4-Uai
APPLICANT'S NAME Last 6 d�
First Ko
Applicant's Address
Applicant's E-mail Address
IZ-o-rus-riw Ave --STe\CO3
City NEWPORT Oi Esc -14 State h
�...
Zip 266 3 Telephone 510) 7 , " 4 L annet
4 ,t �7r
ARCHITECT/DESIGNER'S NAME Last �� First I Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City -- ---� State F_—zip
TelephoneF_
ENGINEER'S NAME Last fJ. t_ t.. L N
First G. FC. Lic. No.�j 182.
Engineer's Address
Engineer's E-mail Address
IdIG7 X05 MARY PLACE-
ekal�cnSeerr►I�Is rin , cor+,
City G O STA M IF504 state Gp
,
Zip q ytpti'7 Telephone(014M) 5 +8.71 44,
CONTRACTOR'S NAME/COMPANY�'* . f - Class r
OWNI-�Z-6U1�.L7E� Lic. No
Contractor's Address
Contractor's E-mail Address
City �� State F_
Zip �— TelephoneF_
SETBACKS REAR SETBACKS FRONT
PERMIT NO. ( 6
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $