HomeMy WebLinkAboutx2021-3102 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application
��%/1 ' 510 v City of Newport Beach - Building Division
F- crmI ( Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading rDrainage [bec rMech rPlum cuvdcut
F cuvdFill
roject Address (Not mailing address) F_ Flood F_ Fire r Liq r' Landslide rN/A Floor Suite No
✓i0a TPamo47o 1V19WPr,-7 <,4 10-0-1 F_
Description of Work
I Use ConstType
AV Gazebo elec� �r9h� .uNCT 5W,'1c4
f #Stories #Units (if Res)
F
W wcj
� Remodel SF f5Garage/New/Add Valuation $
New/Add SF5 h
><) Material/Labor 2
OWNER'S NAME Last First
Ownner's Address Q Owner's
fE-mail Addressp ,, .
Hn
City �gr./�pp% 8p h State Zip _C Telephone 151 — 5.�V 3335
APPLICANT'S NAME Last -S
Applicant's Address
25626 Crown Vo4e,,V
City lit ✓a a 7\-r— i1 state GA
First fey; jj ovl
Applicant's E-mail Address
Zip Telephone 9�►°► 66 /3-3i 4L�
ARCHITECT/DESIGNER'S NAME Last C(jl
�lO,iSeINI First
Architect/Designer's Address
G z �'. 6t�i ffraeT
City F Long!. 3eaetj State G Fi
Architect/Designer's E-mail Address
-- _ --
Zip 'JO �p3 Telephone 5562 212.. goo
ENGINEER'S NAME Last First Lic. No.ir r-11
Engineer's Address
City State �®
Engineer's E-mail Address
Zip Telephone
CONTRACTOR'S NAME/COMPANY C f3 kM E . Zn G
Contractor's Address
z56 a6 Gr'own ✓u.ltGy �K�✓y
City j -a pt n� State 16
Lic.No. 1Class
Contractor's E-mail Address
�'runf� /Cmrn
Zip 7I / Q4 Telephone Qi/ _r7G�
SETBACKS REAR D I SETBACKS FRONT I 0
PERMIT NO.
SETBACKS LEFT 0 / SETBACKS RIGHT O � PLAN CHECK NO.
— TrJ1 - ern .
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