HomeMy WebLinkAboutX2019-0528 - Permit Application�. Print Form _ Worksheet for Combo Building & Solar Permit Application coos
r Comm'I r, Residential City of Newport Beach - Building Division 03gd ,201q
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL X2O1�1-OSZS�
-Building (—Grading F -Drainage l./Elec R/Mech f—PlumCu Yd Cut CuvdFill
Project Address (Not mailing address) F_ Flood r Fire r; Liq f— Landslide F'N/A Floor Suite No
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F_ F_
Description of Work
Use F'; Const Type 1—A
# Stories[ # Units (if Res)[
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Valuation $ 1700,t7 o
Material/Labor
New/Add SF� Remodel SF (p$g
Gara a/New/Add F_'1
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OWNER'S NAME Last
First a y�
Owner's Address
Owner's E-mail Address
700 tkWP04 C,ey�tef- ?M'Ve_
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City JPD1.� Qppk State Zip Telephone oqq) Zm_3oll►
APPLICANT'S NAME Last f I t o p}3 First AAtp
Applicant's Address J
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Applicant's E-mail Ad_dress
4_170 L s pave.
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City j GVH_ State I v'
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ZI Tele hone
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ARCHITECT/DESIGNER'S NAME7
Last FW First Lic. No.-33(92
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Architect/Designer's Address
Architect/Designer's E-mail Address
-70 Co Id& D►'F.
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X651-3
City Ne t�pw State I
Zip G12 (y�� Telephone (q`1q� 6T)0
ENGINEER'S NAME Last
First,, Lic. No.
Engineer's Address
Engineer's E-mail Address
City State
1
Zip l Telephone
CONTRACTOR'S NAME/COMPANY//V(�
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Lic. No.F lCl bi Class �7 C
Contractor's Address
Contractor's E-mail Address
4160
City /D Gvl State�CjQ�
Zip /�`J` �jr Telephone -iim _ eoo
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SETBACKS REAR SETBACKS FRONT
PERMIT NO. xgAat -0 s
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $