HomeMy WebLinkAboutX2019-4059 - Permit Application-157 COALLS
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Permit pp I M c -,'
:.0LForM Worksheet for Combo Building SV�olar Permit pp ication
City of Newport Beach - Building Division KAN -qD5-q
F Comm'I F Residential Kinrc! mi Am r%wc:r%V 111 IF AT TIME OF: SUBMITTAL
T<uilding F.Grading F7,Drainage Elec Mech Plum Cu Yd Cutl Cu Yd Fill
Project Address (Not, mailing address) [7 Flood Fire F7 Liq Landslide 17N/A Floor Suite No
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Description of Work &1,-W- Ty ConstType
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OWNER'S NAME Last 74pL ZA Fi
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Owner's Address Owners E-mail Address
City State, Zip P?244a � Telephon&_e,13_`�9�_,v2wl
APPLICANT'S NAME�;, ast First
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Applicants Address Applicant's E-mail Address
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State Zip F�� Telephoneb;;�� C
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ARCHITECT/DESIGNER'S NAME �Last First Lic. No.
Arch itect/Designer's Address Architect/Designer's E-mail Address
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city State CA. Zj�j
Telephone
ENGINEER'S NAME Last First A V'S J Lic. No$�
Engineer's Address Engineer's E-mail Address
State zip
City (KO-0570
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CONTRACTOR'S NAME/COMPANY Lic. No. F7 Class
Contractor's Address Contractor's E-mail Address
City State Zip F_ TelephoneF_�_.
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $