HomeMy WebLinkAboutX2019-3854 - Permit Application'Print FormWorksheet for Combo Building & Solar Permit Application ON
F Comm'I F- Residential City of Newport Beach -Building Division )(241q •-_MSqNOTE: P N CHECK FEES DUE AT TIME OF SUBMITTAL
uiIding r Grading F -Drainage F_Vlec Meth F."plum CuvdCut F_ Cu Yd Fill
Project Address (Not mailing address) F_ Flood F Fire F Liq F_ Landslide FN/A Floor Suite No
Description of Work
Use Fr3 Const Type FC5
ow cwaLto ' j 10
RI-Alz Il)'tl vv f~=L
# Stories' # Units (if Res)l
(i WL, µ1T 1Gl
171 W` -/y rL-X V4>r IdIeW LOWUO (ikClwl
r
�K17 aD 2� .cacti t_1ASi9_&41A AW ak 'I)C-m_ Ih7t0._I.WtUk_S�rtur
nation$
New/AddSFI Remodel
SF d I
r`'�Z g�Ne
atenal/Labor Ali
OWNER'S NAME Last
Ss^rz First �11K.E AND S1" W
Owner's Address
Owner's E-mail Address
City (yR
", State Zip gZlO� Telephone 310- 7,63, Z63W
APPLICANT'S NAME Last
(3p,%Le ! First (vitut i
//
Applicant's Address
Applicant's E-mail Address
83 CA GVEW 1)Z (0i ZRU'1roca lx.m4aw.aoi
City I bk6,0rxxu-45
StateF0v - Zip W�T3 Telephone �i - 3 lO RC1
ARCHITECT/DESIGNER'S NAME
LastFirst F
�1 )U Lic. No. CZ t 'f Qq
Architect/Designees Address
/ Architect/Designees E-mail Address
V3 163 C14- o
M -P-1®I vap QN3Rte- cvky
City uni,6jw pi,K-)
State CP- Zip fvo j-_� Telephone CNN -S_7 3 •/dr0
ENGINEER'S NAME Last
11}1u1p First rook t{bs,> Lic. No.1 C(o7Z(D3
Engineer's Address
Engineer's E-mail Address
l3�tl /Z� sTlz�yi S"�1T1§ �
City I CA 10
State G14 Zip I CI(7/0 rd Telephone i7t -q<v--
CONTRACTOR'S NAME/COMPANY h Lic. No. F Class
Contractor's Address
Contractor's E-mail Address
City
State F Zip F Telephone
SETBACKS REAR
SETBACKS FRONT PERMIT NO. W
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. .�
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $