HomeMy WebLinkAboutPV2019-150 - Permit Application_Pr Form Worksheet for Combo Building & Solar Permit Application
r- Comml r Residential City of Newport Beach - Building Division 66141,20oo
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuIId1ng r Grading j'-Drainage r Elec j-Mech Plum j-
i- Cu Yd Cutl Cu Yd Fill
Project Address (Not mailing address) r Flood r" Fire r- Liq j-, Landslide rN/A Floor
Suite No
2572 Francisco Dr
Description of Work
Fn
e
Fz�,��,
u i i ce n i e
(if Res)
New/Add SF Remodel SF �— Garage/New/Add Y�� V
OWNER'S NAME Last Bartolic V
_ _ _ First Nicholas
Owner's Address __ _.__-
Owner's E-mail Address
2312 Fransisco Dr
-- -- --- nicky.boullon@gmail.com
City Newport Beach _ State CA _
Zip 92660 Telephone 949-874-3723
APPLICANT'S NAME Last Stablein
First Sam
Applicant's Address IfF�_
Applicant's E-mail
Address
2102 Alton Parkway Suite Bsstablein@tesla.com
City Irvine... _..State CA Zip �— TelephonedARCHITECT/DESIGNER'S NAMELast FirstLArchitect/Designer's Address Architect/Designer's E-mail Address
CdyState I �Telephone
Zip
ENGINEER'S NAME Last
First Lic. No.r—_.
Engineer's Address
Engineer's E-mail Address
City _...... _... State Zip F� Telephone—
CONTRACTOR'S NAME/COMPANY Sam stablein Tesla Lic. No. 888104 Class C10
Contractor's Address -- -
Contractor's E-mail Address
F2012 Alton Parkway Suite B
sstablein@tesla.com
City Irvine State CA
ZIP [— Telephoned --
SETBACKS REAR SETBACKS FRONT 'ate �1q ♦� PERMIT NO. a
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $