HomeMy WebLinkAboutPV2022-0358 - Permit Application�r �rnt°ormw Worksheet for Combo Building & Solar Permit Application oF�"°°R>
Comm I [- Residential City of Newport Beach -Building Division pv2oZ 0�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[—Building [-Grading [—Drainage [I Elec [-Meth [-Plum Cu vd cut Cu Yd Fill[_
Project Address (Not mailing [- Flood [-, Fire r7 Ligq r— Landslide [-N/A Floor Suite No
address)
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Description of Work
Use F ConstType F
# Stories, #Units (if Res)!
I9 P%( jkAoou�Es t4 tTa Iclzo tov e4mrxS ,¢A 1 fSAT-r
_._. _.. _.
Valuation $ P V
Material/Labor
New/Add SF ff, 715 Ic Remodel SF Garage/New/Add r I
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OWNER'S NAME Last (gf�QB First �000
nPrla
Owner's Address Owner's E-mail Address
_ZIP 60 tpf,-aoo /
City l62>N%� 9F� MfFR _ State Zip F9262s Telephone
APPLICANT'S NAME Last &+P9,4 First VlA!
Applicant's Address Applicant's E-mail Address
53'3 AJFk4vtA-LL ST _ VIN @ BRt 6a rGIFe-5OLAa. C0A
City (0ST4 IFS State F_*_Zip c/26Telephone
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. ,
Architect/Designer's Address Architect/Designer's E-mail Address
City State F Zip �— Telephonel—
ENGINEER'S NAME Last I°'6 QM,fS First FOL)U Lic. No. q l & %
Engineer's Address Engineer's E-mail Address
S VIa &E.LmO1,+TE
City I PANCtto SkNtA MttA1u4ElrA, State 1 -4 Zip _9 0$ Telephone 9q%-Z$S--Slay
CONTRACTOR'SNAME/COMPANY Rik t? -r LAFE a1-DL6it)(L Lic. No. 1- i Class 13t(;i61
Contractor's Address Contractor's E-mail Address
q33 /vfW*.4N ST VINe$14(464TLtFE$0LA-R•(or
City (p 6ca MV'S.F State Gfl Zip Z62, Telephone q p ii _ N1 q - 3 A 3 3
SETBACKS REAR SETBACKS FRONT PERMIT NO.t UZO22- 0359�Z 6
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. PCZa2Z-7t
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $