HomeMy WebLinkAboutPV2019-162 - Permit Applicationuv� qhli y V ` 05Ljq
Print Form Worksheet for Combo Building & Solar Permit Application
(— Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
�Af�'P09T
a
r,Building F7, Grading F–Drainage KElec rMech r7Plum Cu YdCut F Cu YdFill F v
Project Address (Not mailing address) F Flood j- Fire r' Liq r Landslide r7N/A( Floor Suite No
I�iz7 Vb IY� �(iQ�DtC,Q,_ I
Description of Work
UseConstType
_ -
i7 6�
�yvla is �(�
5 s�
avid
#StoriesF—, #Units (if Res)
Valuation 'JL
Material/Labor bor 'IJ
(cec� Iwver��C251 hlLc,� 125/ Su✓�aln4-�1 Y12cJ 10(i�F �15Ld1Yta.�}
New/AddSFFRemodelSF� Garage/New/Addy
A0PfLWAW1JAME Last a - � First W(
_ Owners Address Owner's E-mail Address
IoIRZ C 1 u�t �- - yvi �iu�t Gvl �s
City_CAAIVI �b� -__._ L State Zip l " lL 1& Telephone '!6 sls b I
0(d0EY.'s NAME Last �p�a(0(Z --. _...... First I kbbm�
"CU1
Applicant's Address Applicant's E-mail Address
'�z?,ozo RW1G C) VI/t CS
-_-...
p���� �,�A,Af '/
City (..CJf &, �I VVIq,� State �� Zip ��.j trJ. Telep�e�',
ARCHITECT/DESIGNER'S NAME Last _._ -.. First'; Lic. No. F_'..
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip �— Telephoned;
ENGINEER'S NAME Last��^p, _ First _—! Lic No.Z'70j`6y
_•'�'J1
Engineer's Address Engineer's E-mail Mess
3o0o , &,�cL( S� lel to & tPasolae ns,t
City 17th -- --_ State Zip _qu'Zt..._ Telephone�G�,l.l___��3
CONTRACTOR'S NAME/COMPANY-; Lic. No. "(`I't(jej Class
— - AYE
Contractor's Address Contractor's E-mail Address
Io1�4Z-Cov(� t tM 1-7rL - 1✓k�uQ�le+�et� .CSS
City r LA vj 'I„ State F eW Zip' _fit A67 Telephone �k_ qq,1
_ \SETBACKS
SETBACKS REAR FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.'/�
USE ZONE DEVELOPMENT N PLAN CHECK FEES $
i