HomeMy WebLinkAboutX2021-1899 - Permit Application)�i.2c)at
Pant Form Worksheet for Combo Building & Solar Permit Application
F- Comm'I r, Residential City of Newport Beach - Building Division %~\
NOTE: PLAN CHECK BEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood f— Fire f" Liq (_ Landslide F_N Floor Suite No
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Description of Work
5L3 Const Type V_16
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# StorlesF-L # Units (if Res)_
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78 Remodel SF o4
New/Add SF 77 �
Garage/New/Add �,yq
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Valuation a S
Material/Labor Fz o00
OWNER'S NAME Last fi kie-l.au r
First Dev tS
Owner's Address
Owner's E-mail Address
15 Cjelvhev.�
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City Flew�at•i c.\...... ZiP °1Zfo6. O Telephone gyet' 31S' LiS36 ._.. ...
APPLICANT'S NAME Last
First D vte�
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Applicant's Address
Applicant's E-mail Address
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City `�uv... f•ltQS _ State
ZiP alZ6 S3 Telephone AL -,L• 5-d3 ' tD t _ ... _.. .
ARCHITECT/DESIGNER'S NAME Last (�e..lcl. First Oc..u:ca _'', Lic.No.GZ-l4oy
Architect/Designer's Address
Architect/Designer's E-mail Address
Z 5183 Le L t.4_ Dr, Suite to\
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City I l..n_ u RJlly State I e:i
9 �.
Zip ` -t_&S .. Telephone 5 o o
43 qy� • �3 • t S
ENGINEER'S NAME Last J a t d wti
First ;,,,, ,ty Lic. No. L(e5'LS5
Engineer's Address
Engineer's E-mail Address
yaeo Q�rro-vcn� Q�fluWw-\t Sud�G LSA
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city I -S�rutvs State F ek
Zip 47 -(,a1 -k Telephone q�et /,S'-1. 0 5h
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CONTRACTOR'S NAME/COMPANY l / C gofv jnc Lic. No. '�V4_3', ClassFS
v V'vCoont'ra`cttor's
Contractor's Address
E-mail Address
51 2 s �, cr\,
city Ut"ItNMN 1�/cag�/ State l �! /y,/�� 7
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Z1p 1U6µ? Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. !XJ Lh
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $ A Z� (� r'J • %�