HomeMy WebLinkAboutX2021-0099 - Permit ApplicationPrint Form i Worksheet for Combo Building & Solar Permit Application
Comm'I ,Resider —0U 9 y City of Newport Beach - Building Division
ION 3 UW"17/1 [p AOT4: PLAN CHECK FEES DUE AT TIME OF SUBMITT 4... .
F?ABuilding r Grading
r;Drainage VElec rMech r Plum cuvdcut� CuvdFill
Project Address (Not mailing address) r Flood r Fire r Liq f/ -Landslide rN/A Floor Suite No
19 S3 Vt bdr-..
CA 9acd00 7— -'
Description of Work
Use Tl!/lil/ Const Type
►l/ r
oom oradtAizzy�- Gzvvu�t/d-Ord V1 iv4o
# Stories' # Units (if Res)
_ _
Valuation
Material/Laa bor
New/Add SF \IPJ _.
Remodel SF Gara a/New/Add
g
OWNER'S NAME Last /: � First m +e
Owner's Address
Owner's E-mail Address
City
�C'� "49-30n—Zrj&p
o
pxv� State Zip 9,;Z-- Telephone
APPLICANT'S NAME
Last First ^ ,� y h
A A
Applicant's Address
Applicant's E-mail Address
3257_ .mho
(._x\ d�'ctnc� 1,corn
City� a
� State Zip � Telephone ^�
ARCHITECT/DESIGNER'S NAME Last \ First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
(RO`?
City State
_C:,R�
Zip _� � Telephone 714 -.'j�— + 1_
ENGINEER'S NAME
Last \ /^ „( First Lic. No.
Engineer's Address
Engineer's E-mail Address
1_lz 6k- CkaJ
kC, �e b - ev�5ine�x �t ctxY
City �cQ
O
State ��' Zip q Telephone
5' CONTRACTOR'S NAME/COMPANY — t Lic. No. Z lass
Contractor's Address
Contractor's E-mail Address
325-1
CityCR
State rZip I l � r ^ Telephone194q—
SETBACKS REAR 6
SETBACKS FRONT U ' PERMIT NO. OO GI
SETBACKS LEFT �—
SETBACKS RIGHT T— PLAN CHECK NO. 1�>
USE ZONE /2-1
DEVELOPMENT NO PLAN CHECK FEES $