HomeMy WebLinkAboutPV2019-170 - Permit Applicationpq�vq - � 1 o
yFrlmForn Worksheet for Combo Building & Solar Permit Application
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City"of Newport Beach - Building Division 51�11� 0 o
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITT
.Building r Grading rDrainage r- Elec f- Mech F_Plum CuvdCut F CuvdFill
Project Address (Not mailing
address) F Flood 7_ Fire 7- Liq (- Landslide 7_ N/A Floor Suite No
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Description of Work
Use F Const Type pl
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# StoriesF;j� # Units (if Res)r
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mvaluation
New/Add SFF— Remodel SFF_ _ Garage/New/Add � � W'.
$ OO
Material/Labor o
OWNER'S NAME Last
Owner's Address
First
Owner's E-mail Address
City W1 Y-CAo. Uej �nA._,.tM F Zip Telephone�.State 42&2-5
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APPLICANT'S NAME Last
First.
Applicant's Address _ Applicant's E-mail Address
City _./�, r/X,,,.
State zip 42. z.. TelephoneF(1yq 3ZG-3/&2-
ARCHITECT/DESIGNER'S NAME
Last �... , First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City F_
State F— Zip F— Telephonel�
ENGINEER'S NAME LastLki✓
: First A ,�j� Lic No. C Uq I &
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Engineer's Address
Engineer's E-mail Address
Address
ZZ 1 b1lk /l*v&_
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City CSA
State F, Zip Telephone(141)2-?5-5-10q
CONTRACTOR'S NAME/COMPANY
1. L J ,y„ Lic No. �ZC7 Z6 7Class (p76
Contractor's Address
( 9 3 3 /U�aCI 5-
Contractor's E-mail Address
City I COS4,:k_.....V ,lelµ®._
State I�%r�..... Zip / Z& Z 7,,, Telephone.. .68 9- . 9.33
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
7
SETBACKS RIGHT PLAN CHECK N0. Z�S�-
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $
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