HomeMy WebLinkAboutPV2019-178 - Permit ApplicationPYlnt�4rm,.i Worksheet for Combo Building & Solar Permit Application 5' o���°°q>m
j— Comm Residential 1� ^ City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
�ruilding F! Grading j—'Drainage I—Elec F,, Mech r' Plum Cu Yd Cut F_
Cu Yd Fin I_
Project Address (Not mailing address) r— Flood r Fire r Liq F_ Landslide r_N/A Floor Suite No
293D �}I-1, \fi,s'�. �, /V, r�, Gly g2Ce6po F
Description of Work
New/AddSFF— Remodel SFr
Use F Const Type
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'f� b0Valuation$DOo
Garage/New/Add Material/Labo
OWNER'S NAME Last ,r -O i AA— First
Owner's Address Owner's E-mail Address
293x4aL Vrs- Vr
city I N.._3 _.. _.. State 1 E Zip Telephone 7s7- 8"%93.__
APPLICANT'S NAME Last I yr-rVz&6 First I SPS
Applicant's Address
1133 "1101l( S�_
City l os•c, YAsc, State 1 c.7
Applicant's E-mail Address
54a4,40b( �/,�sa/urrCGq
Zip q2,& Z7 Telephone(rey 32.G -3/` 2-
ARCHITECT/DESIGNER'S
ARCHITECT/DESIGNER'S NAME Last First
Lic. No.
Architect/Designer's Address
City State I_....._
Architect/Designer's E-mail Address
Zip r— Telephoneh
ENGINEER'S NAME Last , ,C First G` Lic No. 3C
Engineer's Address Engineer's E-mail Address
cry�
City I State l C)Ar Zip /2 /Telephone
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City I Lose. State I CA
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
SO &r Lic No.(�2� 7 Class C /(�d$
Contractor's E-mail Address
Zip 9 2-7 Telephone 90 y89-3833
PERMIT NO. V 1/Qk t / S
PLAN CHECK NO. Z &_J 14 - ZO� t
PLAN CHECK FEES $