HomeMy WebLinkAboutPV2021-158 - Permit ApplicationMY
10*155
Worksheet for Combo Building & Solar Permit Application
Comm'l k =
lesidential City of Newport Beach - Building Division 6y�
NOTE: PLAN CHECK FEES DUF AT TIMP: OF q1 IRRAA1 &O
r- 'bo
r -Building r- Grading r, -Drainage r- Elec r" MeCh r- Plum Cu yd Cut Cu Yd Fill
Project Address (Not mailing address) f-, Flood r- Fire r7 Liq f7; Landslide -N/A Floor Suite No
'Zf)A-2 CC)MMOAr)te ter-%
- �-j New rw-V q%
Description of Work
Use F—Const Type F-
it Stotiesf # Units (if Resf—
lto�,O_lr
Valuation $ III
Material/Labor
New/Add SFf Remodel SFJ Garage/New/Add
OWNEWSNAME Last First
Owners Address Ay Yn S-�(DVUJ
Ownees E-mail Addre
1-2642
City RmVbO \(�f� state zip FTI—�-06-2— TelephoneF-
APPLICANT'S NAME Lastl Woffe's First emi I'l
Applicants Address Applicants E-mail Address
10171 CaAlf, CW1ares (E,&Vq1 - 1 &1"ca
-
city krja)n cAew"A.,e, State Fc—i l—Zip jj7f0j'3 Telephone FR6�4—mJ34i
ARCHITECT/DESIGNER'S NAME Last First Lic. No. F
Architect/Designer's Address Architect0esigners E-mail Address
F
City F_- State r zip F Telephonel
ENGINEER'S NAME Last First [�- Lic. Nof-
Engineer's Address Engineer's E-mail Address
City-... State Zip TelephoneF
CONTRACTOR'S NAME/COMPANY
SOI t OX Lic. No. FI�PW30ass
Contractor's Address Contractor's E-mail Address
N7.1 Calif, MtOffiDUID
CA f- WJA Stat
city P�a/yl00 -Ve, elirt zip P Telephone, 6,;."
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $