HomeMy WebLinkAboutX2019-0861 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm'I l' Residential City of Newport Beach -Building Division )(2019-086►
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL p 5R%? -2019
rBuilding r Grading rDrainage r Elec r Mech
(- Plum Cu YdcutF Cu Yd Fill F
Project Address (Not mailing address) r- Flood
r- Fir - Liq r- Landslide rN/A Floor Suite No
Description of Work
Use Const Type N t
# Stories #Units (if Res)
�WJ 'D�tAal�n °(reah�h
Valuation $
New/Add SF 22ej S.F. Remodel SFF- Garage/New/Add r-
Material/Labor
OWNER'S NAME Last �1 �
First 1 "4
4 '
Owner's Address
Owner's E-mail Address
Z 5wit 'swo
AJ'PvRCBu..e R,Trt AAAetAL-6 ovP, Coiv\
City (.41 1 -kAtAl state I I4+
Zip F012k57 Telephone 310 • ql3 57G4
APPLICANT'S NAME Last First
(SKANn A8¢t rOMS, trFC,�
Applicant's Address
Applicant's E-mail Address
Z. TIAeAC4
51N6 P_ 5LM,u0AWA rf`C45. Coro
City /�USo JIpJU State
Zip 417M Telephone 1qq-(,-rt-,so4
A CHITECTIDESIGNER'SN E Last rjgq�p
�5-wo Aa¢l�rr5, (At
First Lic. No. Q-Qq$1S
STE.rf
Architect/Designees Address
Architect/Designees E-mail Address
2 TAClM/h
5-t" e_ 5TA,aoA�ukl fEt l5. to. ii
City kmo V Iqo State I �
Zip 6_1 ,( S(, Telephone �+-,- (01"1 •°130 4
ENGINEER'S NAME Last I ROOTAQ First I -rA96IC Lic. No. `j 4m
Engineer's Address
Engineer's E-mail Address
31645 5u4(k 0,OA51 f6(,JwA�TThRbKC
TMrtSE. eo11
City I LAwjk �,� State �-
Zip a?LSI Telephone q4a 4gq_Gz54
CONTRACTOR'S NAME/COMPANY 25 I -A (EV -S
GcotesaArly Lic. No. FR,e 215- Class
Contractor's Address
Contractto�or's E-mail Address
;OC'i'Z 3:1 6� sE .A �'i2,v� SVi:E 145
FSt�V'� ZS MYc.QSr_dn>'a �f.Y .1_601
City i.— A G— A Nd t w c. State C_ A
Zip q Z6�'-7 Telephone cl y q S4 2-L4000
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Q ��
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $