HomeMy WebLinkAboutX2021-1437 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
omm'I r Residential City of Newport Beach - Building Division
NOTEPI AN r.HPCK PPPC nl IP AT T11.1 ,
- ... -..n� yr OUDMI1 IAL V
"Building (—Grading rDrainage rElec rMech rPlum Cu Yd CutF_ Cu Yd Fill ''Project
Address (Not mailing address) r Flood r Fire (— Liq f Landslide f N/A�Floorr Suite No
�Olb'� �iRCN Std2�ET
I I 10�
Description offt Work
Use Const Type 1,_ B
G�1 th'iVR�Ta j2 ��-�� •� �'
2
# Stories # Units (if Res)F
Valuation $
Material/Labor
New/Add SF�— Remodel SF I
Garage/New/Add �--
OWNER'S NAME Last p , (��
First ��q 1
Owner's Address
Owner's E-mail Address
`lCILIa ATI 70
City VA, State F� Zip Telephoner
1
APPLICANT'S NAME Last_—
First
Applicant's Address
Applicant's E-mail Address
City State F_
Zip [— TelephoneF_
ARCHITECT/DESIGNER'S NAME Last h-
GS s<}
First I'i� (1}� Iq -MIA 6•6 Lic. No. �' Zt-A C, li
Architect/Designer's Address
C
Architect/Designees E-mail Address
31� �i,A)�I1 F-D., S--re 23\
pp 11
AA&jAGAAA4 eSI"->h LC,, J CC M (may AIN
City (Et'D GS D C, Ake State C N
Zip q I S,,o Telephone � (D -. { i &. —1-1 � 4j
ENGINEER'S NAME Last
First F_ Lic. Nof—
Engineer's Address
Engineer's E-mail Address
City I State F_
Zip F_ TelephoneF—
CONTRACTOR'S NAME/COMPANY tr5.�. (� J- Lic No. 1tTw' Class�—
K
Contractor's Address
Contractor's E-mail Address
3(k t}AtLkA (ZID. , s wt
M
City —( vkc,a SAS 0 `,A xs State CA
Zip q 13--yo Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. %
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $