HomeMy WebLinkAboutx2019-2839 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Applicati®n`v o -Rb
F Comm'] R sidential Ci y of Newport Beach - Building Division ) g
% NOTE:/LAN CHECK FEES DUE AT TIME OF SUBMITTAL
i
VB ilding F_ Grading ainage A'Elec F-fYlech lum Cu Yd Cut Cu Yd Fill �1rS// �1 �� '' V(tjeCt
Address (Not
mailing address) C Flood
Fire Liq j— Landslide _N/A Floor Suite No 1
5-00 L�rd b
Description of Work
U*set nstType
# StoriesFT # Units (if Res)
Valuation $
Material/Labor �f✓ "
New/Add SF Remodel SF l 4 (p
Garage/New/Add F—
tZ
OWNER'S NAME
Last.I'l—
First
Ownerr'�'ss/ Address
Owner's E-mail Address
SVIJ� V�'3 SL h�•j V/In
cA'uNaPgt(d c2 nuc
City r P"c^✓ 6 y f�Ct 1 State �— Zip �1�Ctlr ^Telephone 'z 7 rt; Z��2
APPLICANT'S NAME
Last(LA U —
First
Applicant's Address
Applicant's E-mail Address
City [`
� State [_
Zip [_ Telephoner—
ARCHITECT/DESIGNER'S NAME Last First i�C.VGt" �
6lie,'o Lic. No.
Architect/Designer's Address
Architect/Designer's E-mailAddress
TdiKfFist4t,�<CrFr
7C'c ('.fa,V ct;Iv'G'CU 7'/1Cr� U �eZj �`�a (CJiU7
Cit Y C.-Uv}ac
State (/
p �JG�f Z Telephone t
Zi C� I� j f - i S
ENGINEER'S NAME
Last `,� kiz
First Lic. No.1
Engineer's Address
Engineer's E-mail Address
� r'ict)j-. � / �
City
Ce n 211 T V
cCc r � csh G_ r�� � c. L.� ya7
f r 4k_
State q-
Zip o ` 7-:� Telephone 3/G ._
CONTRACTOR'S NAME/COMPANY 1 1�
Lic. No. Class F
Contractor's Address
Contractor's E-mail Address
City 7—
State F_
Zip F_ Telephone
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. ( j
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. 2 r -
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $