HomeMy WebLinkAboutX2021-0201 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
F- Comm'I r Residential City of Newport Beach - Building Division Uc
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Nuilding Grading gPrainage N�Elec It,,Mech
VPlum cu yd cut[ Cu yd Fill F
Project Address (Not mailing address) F_
r Fire F_ Liq F_ Landslide F_N/A Floor Suite No
Description of Work
Use h 3 Const Type r5
f
Pks16a New 3'S�r \ SftL wt rcu` a%c 6.
I V
# StoriesFT # Units (if Res)[
l-Star-A
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Valuation $ W.
New/Add SF , ryS''L Remodel SF I ° Z; Garage/New/Add 5 i t Material/Labo 1 / M i%0 2
OWNER'S NAME Last per-(t bo
First I &,AC-S
Owner's Address
Owner's E-mail Address
1-148 Ptwu pea tJ>r�C
City I 0".vk 6ec. State �—
Zip R b1 Telephone gyq•Z,k_ tb,0
APPLICANTS NAME Last � ,ok"
First
Applicant's Address
Applicant's E-mail Address
23\S j Le (cAeva Dr. Suiit tOk
v:e\ r7e\LCje-r�1 . r��n
City L.�,Uvw N+t\5 State I - r
Zip 5Z6SS Telephone 944. T"050
ARCHITECT/DESIGNER'S NAME Last r3a 6tn
First �� Lic. No. 77-i-Ao4
�
Architect/Designer's Address
Architect/Designer's E-mail Address
zit8 5 Lk 144et.s- Dr. S0 te- \o\
A:.%A adL(p c(c L,. Ca,....
City �u ^y N. (\5 State �'
Zip -t-65 j Telephone q�14.513. toy,
ENGINEER'S NAME Last W;\yam
First Lic. No. G g3 153
Engineer's Address
Engineer's E-mail Address
z.31171- Ucrdc),�0 Dc. to-?-
>A/dslAV►9tvltode(.-.0V&4*0(5e-e-0V,.
City za uv \{y\v5 State Fzi�_
Zip GZ(fl5'S Telephone-ity.5i6.65,---t
CONTRACTOR'S NAME/COMPANY
Lic. No. F-- ClassF—
Contractor's Address
Contractor's E-mail Address
City State F_
Zip F_ Telephone=?,0Z1
-Poo/
SETBACKS REAR SETBACKS FRONT
PERMIT N
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USEZONE DEVELOPMENT NO
PLAN CHECK FEES$