HomeMy WebLinkAboutPV2019-190 - Permit Applicationit 10
Pnnt Form Worksheet for Combo Building & Solar Permit Application
[I Comm'I [7 Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building [ Grading [Drainage ❑Elec
Project A
Description of Work ieffy
I /laQ kx r, t tl S
[ Mech E Plum
[Flood ❑ Fire [ Liq ❑ Landslide
Cu Yd Fill F]
[N/A Floor Suite No
77
Us
-� e F71Const Type u
/n'
J ItStoriesEl #Units (df Res)[7
5' Valuation $
New/AddSFRemodel SF Garage/NewlAdd Material/Labor �l
OWNER'S NAME Last
k:h(�di,l First i7 Owner's Address Owner's E-mail Address
Cit Lu ,:
Y ^l.s �--j •E.t`-LC, State— Zip Telephone
APPLICANT'S NAME Last 7 n(23 m z i First '
1�- cry
Applicant's Address reeApplicant's E-mail Address
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VA, - V, ti �siJi'i tJ�I�IWci� f� tea: 'D��t
City State ) Zip I gviti'C,& Telephone
ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
I
i
City �— I State j
FirstI
;zzs, ,i Lic. No.
Architect/Designer's E-mail Address
I
Zip �� Telephoned
i
ENGINEER'S NAME Last First Lic. No.
Engineer's Address
i
i
I
City State
Engineer's E-mail Address
Zip j Telephone
CONTRACTOR'S NAME/COMPANY
T o;;j � � � Lic. No. Class
Contractor's Address
City '�6State s�-'-t. i
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USE ZONE DEVELOPMENT NO
Contractor's E-mail Address
ZIP 6L,�, Telephone�j
PERMIT NO - %7101. 10? 0
PLAN CHECK NO.
PLAN CHECK FEES $