HomeMy WebLinkAboutX2019-3265 - Permit Application (2)Worksheet for Combo Building & Solar Permit Application o4�E.t.
F Comm'I F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI AL G,,.o...
ffBuilding I —Grading f—Drainage tElec F/Mech %Plum C. YdCut l Cu Yd Fill
Project Address (Not mailing address) f Flood f— Fire r Liq f Landslide i—N/A Floor Suite No
502 && o
Description of Work Use ConstType 9�
NlC Uj rC5�d
# Stories # Units (if Res)j
Kk 6
Valuation $
New/Add 5 e ode) SF Garage/New/A d 3�2. Material/Labor
OWNER'S NAME First
1
Owner's
Address `- ` / Owner's E-mail Address (
_ (_ '�l4`tfJ--`O'Cl We ?ar /n co (`L� �p�QCr C3S�{�Frlvdcf/I-C O/ti
City State
CA
C (1 Zip 10? Telephone)_
APPLICANT'S NAME Last I 5 1
O M First 3 O n
Applicant's Address Applicant's E-mail Address
City Ct n C t c State CA Zip � 4( G 7 TelephoneF '?_
S` 5 z �-?Sz
ARCHITECT/DESIGNER'S NAME Last '5 First —
5 ILC fano �inrl Lic. No.,35a7s
Architect/Designer's Address Architect/Designer's E-mail Address
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5 nr _ �( 610� CS4 enadC(h,ci-,
City - Sum C /G(7Cr . C C, State �C -- Zip ( ---_-- Telephone
5 ��(�� 57ts -5 �,. go6�
ENGINEER'S NAME Last 7_u 7(j First p0.v Lic. No.� QCT S�
Engineer's Address - Engineer's E-mail Address
3tI �d�wlncEe e� 5�c Zoo C!z,�doPian--nor
City O t State ` Zip ' 0 -? q Telephone Z Uf -1112 3 -7 yy
CONTRACTOR'S NAME/COMPANY1 Lic. No. R�3 33 Class 7e
C
S� M0CiC
Contractor's
Address _ Contractor's E-mail Address
C
City —5 � State � Zi cr (_1
Ci/1.et�c.o LI n PI. L �U Telephone f)����� (�S�
SETBACKS REAR SETBACKS FRONT PERMIT NO. x1y M
SETBACKS LEFT SETBACKS RIGHT:: }. PLAN CHECK NO.
USE ZONE 0 (� .� `/ DEVELOPMENT NO „� ( ) PLAN CHECK FEES $