HomeMy WebLinkAboutX2019-0624 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application " °°R
L, Comm F' Residential City of Newport Beach - Building Division 1=
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F;Building F_ Grading Inage F_Elec rj Mech ,Plum Cu vd Cut F_Cu Yd Fill F_
Project Address (Not mailing address) F_ Floo � ire F_ Liq F- Landslide F_N/A Floor Suite No
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Description of Work
Use F—ConstType F
Ket 14C-s 05 F-x,1:0w1aVr tNm t4MrV ,are
Stories q Units (if Res)[ —
Valuation $
New/Add SFr_!. Remodel SF�i, Garage /
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a rial/ 6or (f(�
OWNER'S NAME Last ton Lam, }�nYi l`v ){�(i �l 1 � - First
Owner's Address Owners E-mail Address
1 �' \(,DiZL S L �'� i 13
City �- �� State F—, Zip r—TelephnneF_;
APPLICANT'S NAME Last CA n 1� �J �,_� 5l` �-J ,�✓,�l:.first
Applicant's Address Applicant's E-mail Address
Zip c� ZL%U , TelephoneF�6 1,S 'l 2 3-1
City � StatefI �-n-
ARCHITECT/DESIGNER'S NAME Last , First F Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State F— Zip F—Telephoned
ENGINEER'S NAME Last O [ p /JN ELL First PoE V I N Lic No.
Engineer's Address Engineer's E-mail Address
I1[50 5.OL1VE ST 1600 kdVC_00ylz1t@ 5]gk.00w
City L(�s f1, 66, E State I Gr Fl Zip q 00) Telephone � I 3,-a? I -aOOO
CONTRACTOR'S NAME/COMPANY Q DM` Ir 'L . - f Qri �Wjf� Lic. No. j Z q 2L4q Class C
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Contractor's Address Contractor's E-mail Address
26(6-1 c R , 13-1 v3N e. rdmcoy4weii . corn
IN Telephone
City di(U State Zip �g .� I Z tq _ yd{ 9 _734
SETBACKS REAR - SETBACKS FRONT PERMIT NO. Y"a101C1 -0 (4
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SETBACKS LEFT SETBAF2 CKS iGHT PLAN CHECK NO. ()1U3,2-019
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $