HomeMy WebLinkAboutX2019-1763 - Permit Applicationy2 it -01W3
Print Form Worksheet for Combo Building & Solar Permit Application
rl; Comml (Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
%Building F Grading FDrainage RElec
Project Address (Not mailing addrei
/7y.5 4L`4ND
Description of Work
1.dl/D /%/JAS
Mech Vplum Cu Yd Cut Cu Yd Fill
r– Flood F–,, Fire F_; Liq rj Landslide
LANs
Cm c-iliT 4 T
Floor Suite No
Use F__� Const Type V3
# StoriesF/_l # Units (if Res)I
New/Add SFF Remodel SFRValuation S
Garage/Ne/Add-a/New/Add
d 9 Q '.. Material/Labor
OWNER'S NAME Last �E����zJ� First /Jl �✓I/C/.w
Owner's Address Owners E-mail Address
City ��-�✓rvn'b--- J�Cr�LI� ,, State Zip /L'v�r6 Telephone %/Y off/ -4 /lZ
APPLICANT'S NAME Last I IZI0
Applicant's Address
<S;7z 6v41-,
CityC- .._ State
First
Applicant's E-mail Address
,- Ce 5rrs p e _Cry
Zip ✓fZo/ _ Telephone c�;,/
ARCHITECT/DESIGNER'S NAME Last I _ First II Lic. Lic. No.
ArchitecUDesigner's Address
City _. State F
Architect/Designer's E-mail Address
Zip Telephone[
ENGINEER'S NAME Last I— First 7—! Lic. No.
Engineers Address Engineers E-mail Address
City State Zip Telephone�—
CONTRACTOR'S NAME/COMPANY �"4 jd/�yT ff �C�/�riwt�7%L� � Lic. No. bfo // 4/ Class
Contractors Address
City State F71,
"
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
ce05_0c,Fd7Le�
Zip 6/�'. Telephone
PERMIT NO. _X 2 -01C -A--
PLAN CHECK NO. Z(oO) - ao lc)
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $