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HomeMy WebLinkAboutX2019-0393 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application F Comm'I F_ Residential City of Newport Beach - Building Division Z , 0 3 NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTA 1. wilding r Grading Drainage �; lec �Mech Plum c.vdcuc'cuvdFiu Project Address (Not mailing address) F_ Flood F_ Fire Liq r Landslide I J N/A J Floor Suite No iJ F� Description of Work A byr)LTW 5 f 4Z_0 Use � 3 Const Type I #Stories # Units (if Res)[ $ O 2� New/Add SF �2'7 (�' Remodel SF Garage/New/Add Valuation Material/Labor 2�' ` V Lj�o OWNER'S NAME Last r M=-v1C>f First Owner's Address �.� 1�R-C UIoV l �jiwD �x T::> City �� 41 I N� 1 5 _ State — Owner's E-mail Address pre,t�� � �� ®Y�Hdo . cp_y,.4..___. Zip I-- �77 4, Telephoner (Q . 6-A (- 6 ( qca APPLICANT'S NAME Last I &y C-/4 P V 12f4-Wj First I A\1'A N I rj rz)p4k� Applicant's Address Applicant's E-mail Address I 14 5OVT&} CA-M G..,t0,4 AQR,*4 6tI L14 j f6" lNt1�s`rrubNrs. r� City v p0 -�-�p State Zip R (9 Telephone (©-445 ? •• ZZ'? T ARCHITECT/DESIGNER'S NAME Last First {� I I Lic No. p Architect/Designer's Address Architect/Designer's E-mail Address Gf��J 7i �� �(�Pcs2lfi U l hJ�o c9Ac(1�5 T1�l�t'�C., City I�cJ G� N �t State Zip �/'� Telephone '7� a `j ENGINEER'S NAME Last I t-1 0 tEA$J*l Engineer's Address ROz3 w Pt co h3L,u) City ,�,�!'1SN� State CONTRACTOR'S NAME/COMPANY Contractor's Address City - ..... .. SETBACKS REAR SETBACKS LEFT USE ZONE First�Lic. No.." Engineers E-mail Address Zip �QQ F/3- Telephonell �(C - 406-204 I I.__-_ Lic. No. F_ Class Contractor's E-mail Address State F_ Zip [_ Telephone( SETBACKS FRONT SETBACKS RIGHT DEVELOPMENT NO PERMIT NO. PLAN CHECK NO. � • �/` PLAN CHECK FEE43 O �f" , 2