HomeMy WebLinkAboutPV2019-165 - Permit Application (2)` Prmt Firm ._: Worksheet for Combo Building & Solar Permit Application ''o
City of Newport Beach -Building Division
❑ Comm'I F] Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL V �
❑Building ❑ Grading ❑Drainage ❑Elec ❑Meeh F] Plum Cu Yd cue= Cu Yd Fill
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ON/A Floor Suite No
910- Lor-- A liar n
Description of Work
Use = Const Type sot
at
8
# Storiest L # Units (if Res)❑
Valuation $
Material/Labor
New/AddSF Remodel SF Garage/New/Add
OWNER'S NAME Last U rLiFirst
Owner's Address Owners E-mail Address -
31G`��1.9c�u��st �
city L°-ls y -:.E.. CCY.Ci� 1 State Zip Q' Cj Telephone � —.l Go
APPLICANT'S NAME Last Y� lC+ First
Applicant's Address Applicant's E-mail Address
oa P*L tFk;M 5v, �tPrez@ lei Int . c®
city I Srvt rtr-.: I State Com+ Zip � Telephone �� lq13
ARCHITECT/DESIGNER'S NAME Last Mira C I First Mo ICS Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address -
City �.. State �.. Zip Telephone
ENGINEER'S NAME Last \rt_y, First _1a r U Lic. No.
'Engineer's Address Engineer's E-mail Address
city State I Zip: Telephoned
CONTRACTOR'S NAME/COMPANY Lic. No. Com' Class
Contractor's Address - Contractor's E-mail Address
Loa 4� {-&q�lcV 7 `S`'e' tIS
I
City 5i Y -v jt e State Zip d Telephone
SETBACKS REAR SETBACKS FRONT .PERMIT NO., 5 vD.1�j
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. !Aot ,, 9,14%
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $