HomeMy WebLinkAboutX2019-4163 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
❑ Comm'I ie Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
EBuilding ❑ Grading ❑Drainage ❑ Elec
Project Address (Not mailing add
y ��{ ofV Ai d Ave_
Description of Work
/Cdo 2411/ l` a eh 4,
❑Mach ❑Plum Cu Yd Cut Cu Yd Fill
❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor JJJ Suite No
New/AddSF� Remodel SF E--1 Garage/New/Add
OWNER'S NAME Last I A - s A G✓
Owner's Address Owner's E-mail Address
,;�76 �lwnes ea r�
City
State ® Zip
APPLICANT'S NAME Last l HfS ! ur
Firstl /LGlM,,,
Use F7 Const Type
# Stories❑ # Units (if Res)❑
Valuation $
Material/Labor
` qq-3304'13`ao
Applicant's Address Applicant's E-mail Address
C C ✓� I
r-- i
City State F-71 Zip Telephoned
ARCHITECT/DESIGNER'S NAME ��
Last J Ol 2e.d First u Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
c�1-/3 / C-
City MAa y,'JJS 'State 5'1, Zip � Telephoned
ENGINEER'S NAME Last First F-7 Lic. No.�,
Engineer's Address Engineer's E-mail Address
City State Zip Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No.
Contractor's Address Contractor's E-mail Address
City SC star o T i w DZZ77�—j 7 57
SETBACKS REAR SETBACKS FRONT PERMIT NO. b
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $