HomeMy WebLinkAboutX2019-0197 - Permit Applicationan -isq (k
Worksheet for Combo Building & Solar Permit Application
Comm'I j residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building i Grading F-Drainage FElec Mech j—Plum CuvdCut cuvdFill
irojeet Address (Not mailing address) [ Flood F— Fire r Liq J— Landslide CN/A Floor Suite No
lescription of Work Use d Const Type
12.1 I • ' a �`' Stories # Units (if Res)s
Sr, s'Crnr Selz. "
Valuation $ ? ,t,q"
New/Add SF I Remodel SF 12 Garage/New/Add I Material/Labor; rl _Ol v � v
OWNER'S NAME Last ASu - First,
Owner's Address Owner's E-mail Address
1149 SAO^. /rt�
City yJ"', C.do-t State F C ,{,t Zip Telephone
N
APPLICANT'S NAME Last ��'�ist,�.�� First
Applicant's Address
112.5 i
City L✓"�!r. State CIA
NAME Last
Applicant's E-mail Address
Zip Ij Qg'l Telephone �(o2._%3
First
Lic. No. F_
ArchitecUDesignefs Address Architect/Designer's E-mail Address
r'r-lq-
city I State ! Zip d— Telephonei
�
ENGINEER'S NAME Lash 1�►�►s�� First lS C.,C� Lic. No.��'� 5
Engineers
iAddress Engineers E-mail Address
` r
City State— Zip i, j Telephone) 11 =S — IUJ�T
LA^
o.. Lic. No. ��/ Class"
CONTRACTOR'S NAME/COMPANY —' 'S-7
Contractor's Address J/ Contractor's E-mail Address
11
\� City6Si�Sr� Stater ZiP' 9c��ro Telephone
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT — SETBACKS RIGHT _
USE ZONE PC- SS 2 DEVELOPMENT NO
PERMIT NO. /\w` l'
PLAN CHECK NO. 1IN -lip
ISLAN CH€CK F€ES