HomeMy WebLinkAboutX2019-0250 - Permit Applicationv 's C.o (pq CSIC? N PERMIT) 00101# 1'S-0q'7S
Print Form Worksheet for Combo Building & Solar Permit Application 00,
'OZ1'j City of Newport Beach - Building Division
Comm'] r ResidentialNOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 11
rBuilding r- Grading rDrainage r lec rMech r-PlumCu Yd Cut r Cu Yd Fill'„
Project Address (Not mailing address) r Flood r Fire r Liq r Landslide rN/A Floor Suite No
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928 AVID CADo AVENUE 1CI-DoBBrop�N �
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Description of Work Z
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Valuation $
Materia]/Labor
OWNER'S NAME 'hE I RV�NE 4J 1 m p,+l{, v
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Owner's Address Owner's E-mail Address
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City iRvlkis State Zip g2(v1 Telephone
APPLICANT'S NAME. I/6 YsIZ�`+C/ (Fori) TRI,�eX4A-r- I 4 P✓WD
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Applicant's Address Applicant's E-mail Address
731 IV W,
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City D� _ StateFOA —.Zip RZS '.. Telephone
ARCHITECT/DESIGNER'S NAME Last �;FV { c - First Lic No.
ArchitecVDesigner's Address Architect/Designer's E-mail Address
City State F___ Zip F_ TelephoneF_'
ENGINEER'S NAME N/
Engineer's Address A
City �— ! State F_; Zip F_' Telephoner—
CONTRACTOR'S
elephoned
CONTRACTOR'S NAME/COMPANY ANG 3 Lic. No. 61j$?j Class $� G�
Contractor's Address Contractor's E-mail Address
731.... ' � _ _ _ _ _ _ 0�/9-(/�-@J B a:D �,CD w► p
City State l Zip RLS TelephoneF&/fi
SETBACKS REAR SETBACKS FRONT PERMIT NO. X ,lb I <-.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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