HomeMy WebLinkAboutX2019-3814 - Permit Application (4)Print Form Wor/ eet for Combo Building & Solar Permit Application O4jEWPogTm
r Comm'I Residential ( City of Newport Beach - Building Division =
54 NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding FGrading inage (-Elec rMech
r-Plum CuvdCut 35 CuYdFill F5
Project Address (Not mailing address) F_ Flood
F_ Fire r Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use �. � Const Type �)3
# Stories #Units (if Res)
I j -FC/�1� -5 t Ie Fs Ti c N QG, LJ,& u- G/r -(pre
L S l�
Valuation $ Q
Material/Labor I/000
New/AddSFF__ RemodelSFF— Garage/New/Add —
OWNER'S NAME Last (,()�s
First
Owner's Address
r
Owner's E-mail Address i
tea¢ Lfi�t2K-S"f�uf�
City N r�
ZipnjZ67_5 Telephone qefo
`State
APPLICANT'S NAME Last Vic, -ram
First �=1
Applicant's Address
Applicant's E-mail Address
c— A-5 L (i5G
City State �—
Zip � Telephoned
ARCHITECT/DESIGNER'S NAME Last �.$ First Lic. No.
6J 1TZ
Architect/Designer's Address
Architect/Designer's E-mail Address
(Cst i GJCSTGL(r(z--Drz-_
wlh.@,j wk"C4Y-r_fiec*i�r�.Cor�
City NL.) State��'...
Zip 2((crco Telephone G4-25Z(Z
ENGINEER'SNAME Last r�l/���KY�s�l First Lic. No 3G940
Engineer's Address
Engineer's E-mail Address
I�oa � l�5(.
r GalC�es� �n^�•caly�
City State
Zip o O( Telephonef/4- 9'3S-2_ad4D
i
CONTRACTOR'S NAME/COMPANY
l l7
Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City State I
Zip Telephoned
PERMIT NO.X*Z0 :
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
,tV
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $