HomeMy WebLinkAboutX2021-1480 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit A
f Comm'I pplication
j�Residential City of Newport Beach -Building Division
FNOTE PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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GrDrainage Elec F Mech F �j— Plum Cu Yd CutCu Yd Fill
ss Not mailingddress) r Flood r Fire I° Liq r Landslide rN/A Floor
cription of Work
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New/Add SF l Remodel SF
Z5 L, F. Garage/New/Add �—
OWNER'S NAME
Owner's Address
City lvt ,p
APPLICANT'S NAME
Last
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9 C � State C 4
Last J_I•L"IP z
Applicant's Address
11�6rr02 �,tV4((ey 131�e1
city G I �oti%e.
State E/k
ARCHITECT/DESIGNER'S NAME
Last
ArchitecUDesigner's Address
First) rjca 'I
Owner's E-mail Address
Zip q_Z
Use ConstType ' �3
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ties L # Units (if Res)
Valuation$ 2 070
7 OGO
Material/Labor lJ
First) )Ulkb
Applicant's E-mail Address
j j j wttx e_
Zip I q.( 752- Telephone 62_).335 yy!55
First
Lic. No.
Architect/Designer's E-mail Address
City I State — —
Zip F, Telephone
ENGINEER'S NAME Last (� j � TZ r�
First I)U I-/ �A� Lic No. 6 -7 ZC� Engineer's Address -
Engineer's E-mail Address
City `
State F Zip [' Telephoned ----
CONTRACTOR'S NAME/COMPANY M r Contractor's Address J��
COnSI QCi 0 Lic. No. �2°�Ip02 Class CkG10 13'
0892 Contractor's E-mail Address
NceI S-fteei Su��e Ill
I I hammy @ WrconWvcfion.cOm .
City LOS klcvnwoS State - - -
C'1} Zip gfl72U Telephone 71 y _,57iO - 5-9-6 I
SETBACKS REAR t0" W wl
— SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT PERMIT NO.
USE ZONE Qj� r� f` �y PLAN CHECK NO.
DEVELOPMENT NO Y/ t��-t/ 'p PLAN CHECK FEES $ t•