HomeMy WebLinkAboutPV2019-081 - Permit ApplicationPant Folm ;- Worksheet for Combo Building & Solar Permit Application
f— Comm'I sidential City of Newport Beach -Building Division
6
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL Pvaoda-® rTl
F/ -Building r! Grading [-Drainage (-,'Elec r,Mech F- Plum CuvdcutF CuvdFill F
Project Address (Not mailing address) (-; Flood
F_ Fire Liq r Landslide FN/A Floor` Suite No
Description of Work
Use F Const Type F5,ofar
# StoriesF, # Units (if Res)F—
&PW ) Z5-5Lk6 pev+ d , xis qOO
G.v41�? vkt_V�fQovti R
Valuation $
Material/Labor
New/Add SFF—, Remodel SF F— Garage/New/Add F
OWNER'S NAME LastI'
_eGif?—A _.
_._ First �_..
Owner's Address
Owner's E-mail Address
City l.fijl ba '., State ��'.,.
Zip 4U,2_5 Telephone �(�y "t�`�f `5$9&
APPLICANT'S NAME Last I I/r\eMtYS
First
Applicant's Address
Applicant's E-mail Address
City I LState �,
Zip Telephone
ARCHITECT/DESIGNER'S NAME Last —
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State F_,
Zip'. Telephone—
ENGINEER'S NAME Last „ �yip,��r=
�' f `J
First ---- Lic No. c ---&&/vs
Engineer's Address
Engineer's E-mail Address
20-7 51 ,del Lwwe
City State �—
Zip 91Z (? Telephone �}4{J 'LSS-
CONTRACTOR'S NAME/COMPANY �fi Lt
SO%Cuf Lic. No. jpL�j2C1 %Class G'/(v7
Contractor's Address
Contractor's E-mail Address
c);-3
City I Cos+%. Y Y_"� � State �—
Zip R2.Ce21 Telephone JL)S If$9 3dj 2, 2,
SETBACKS REAR SETBACKS FRONT
PERMIT NO. fivylom
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. t
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $