HomeMy WebLinkAboutX2019-0051 - Permit Application_Co �1 CZ�PlCrA/ ff;r�rFJ 22� - eve
Print F):r:m:A Worksheet for Combo Building & Solar Permit Application�"m
F_ Comm'I r Residential City of Newport Beach - Building Division �5c`pop
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding F. Grading rDrainage rElec rMech r- Plum Cu Yd Cut Cu Yd Fill
Project address) r Flood r Fire r Liq r` Landslide rN/A Floor Suite No
QAddress �mailing
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Description of Work c>450 L[ (i — 1 LL r4 M� n1t4
Use F_ Const Type F_
# Stories #Units (if Res )'
CffANn�t L 4. - �t r l {�
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Valuation
Material/Labor 9j �
New/Add SFr Remodel SFr Garage/New/Add F__
OWNER'S NAME (,O(W1E9d4Z 'C5t "R'�-
Owner's Address Owner's E-mail Address
City �g�� State C�fl • ZiP CU Telephon /pl3 5 +-7✓��
APPLICANT'S NAME.✓ Rgvl/ F lR-i _MUZFA4,+P_ 1I�lG
Applicant's Address L Applicant's E-mail Address
331. No4 MIpt;q s�-T JA46 (W P';D,49n4
CityI ZP_,aga State MT -Zip Telephone /*
ARCHITECT/DESIGNER'S NAME VA1� Lic.No. gi"53
fArchitect/Designer's
Architect/Designer's Address E-mail Address
City State F Zip F Telephone'
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City 1P,✓(1q6 _. State FM Zip ?f-/ f7 Telephone 4 Z(j
CONTRACTOR'S NAME/COMPANY��M�RK xC d�R J�� b Lic. No. ClassR;
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Contractor's Address . Contractor's E-mail Address
751_ Nor
City vJz, qC, State I `) Zip Rr�� VJ 7f Telephone
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31
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK N10.' • Z.Q
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $