HomeMy WebLinkAboutPV2019-197 - Permit Application (2)VN'LUM-111 t
Pnntl orm Worksheet for Combo Building & Solar Permit Application
Fp Comm'I Residential
City of Newport Beach- Building Division _
NOTE: PLAN CHECK FEES DUE AT TIME nF Fi ianniTrka
fpBuilding E] Grading ODrainage ❑Elec [7] Mach DPlum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) ❑ Flood D Fire [] Liq [j Landslide ❑N/A Floor Suite No
16661 64611&16 5
Description of Work
UseConst TypeFV
FA 11
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w
# Stories. # Units (if Res)
Valuation $ �y2�®
Material/LaUi
bor
a a
New/Add SF Remodel
VJ �— Garage/New/Addl
OWNER'S NAME Lastri(1� 1�1(li�y,nANI� First
Owner's Address Owner's E-mail Address`
11� Ih1W(Jl�ll� 1�1t2U , O St%[®2U(cArr�.Ct,++t�
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City l��iV�lr State �J .ZIP 91-7Telephone 1�C7023 c13�:..
APPLICANT'S NAME LastFirst
��(�-� c
Applicant's Address Applicant's E-mail Address.
Gl�f
City �����.tn�
6y"l Dlq�edt � .State Zip. `ZtLZ.. Telephone
ARCHITECT/DESIGNER'S NAME Last First Lic. No.
Architect/Designer's.Address Architect/Designer's E-mail Address.. -
City state I ' " ' Zip Z) Z'Z-.. Telephone
ENGINEER'S NAME Last I First Lic. No.
Engineer's Address Engineer's E-mail Address -
City State
E771 Zip Telephoned
JJ
CONTRACTOR'S NAME/COMPANYL. No.
LLico.L � Class
Contractor's Address Contractor's E-mail Address
i
City State F771 Zip LJ Telephone)
JJ
SETBACKS REAR SETBACKS FRONT PERMIT NO..
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $