HomeMy WebLinkAboutX2019-0013 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ����PoRa
F- Comm'I F_ Resid�nfaal') ®d13 City of Newport Beach - Building Division 6cq(rop„`P
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
(Building F_ Grading F -Drainage F_ Elec r Mech F- Plum cu Yd cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood r- Fire F_ Liq F- Landslide FN/A Floor Suite No
,936b Vi t
61
Description of Work
Use F? ConstType
# Storiesf ' - # Units (if Res)F
NEW i2rwVT
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Valuation $
Material/Labor 8(]/bD0
New/Add SF� Remodel SF ?J r 6 Garage/New/Add
OWNER'S NAME
Last First fNt Wh-Mg_Tt w- M \)IA
Owner's Address
Owner's E-mail Address
00 10-WV0rt
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City N,Q,_, yrA �ectc i� r State I CP� Zip ej2_ (pv Telephoneky5e_q�o ql cd
APPLICANT'S NAME
LastNVVwZ First `- /
Applicant's Address
Applicant's E-mail Address
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City t QUI
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ARCHITECT/DESIGNER'S NAME Last(� First
�IGIV`� OS@�7 Lic. No.� .,9L. ti d�(
Architect/Designer's Address Architect/Designer's E-mail Address
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City
- State Zipy _ Telephoned
ENGINEER'S NAME
Last C� yVN r-,% First S'a.1,; Lic. No.I 3 D
Engineer's Address
Engineer's E-mail Address
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I I we- / Sv rFe 24 b
Citytri
State I CA Zip I ZI (,, 4 Telephone c�yq
CONTRACTOR'S NAME/COMPANY IAA 11 rr / Lic. No. Fq �rU ClassI c'
,Contractor's
Contractor's Address
E-mail Address
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City [-es 4,0e Ie S
State C� Zip q�/ ? Telephone2.111 -(;Q3
SETBACKS REAR
SETBACKS FRONT PERMIT NO. Y,7_010 — C) 3
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO VWS - C>07 PLAN CHECK FEES $