HomeMy WebLinkAboutX2021-2289 - Permit Application (2)X 2024— 2fZ9Gd
Print Ford, Worksheet for Combo Building & Solar Permit Application
F_ Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIMF OF Sl IRMITTAI V c
v
rBuilding r Grading (Drainage rElec j"MechF
Plum Cu Yd CutCu Yd Fill
Project Address (Not mailing address) I Flood Fire .r Liq r- Landslide F_N/A Floor Suitee N..o
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Description of Work `
Use I— Const Type F_
L4 L War/ �u'sr
# Stories #Units (if Res)
Valuation $
Material/Labor � 22od =
L -Eo 11II�/�i.
I'"----"'—
New/Add SF 2.►. $7 Remodel SF
Garage/New/Addl------
OWNER'S NAME Last r '-First
Owner's Address
Owner's E-mail Address
City ah, 6 State
Zip F4A 651 Telephone c/Q Q- S10 /
2
APPLICANT'S NAME Last �r`yL
First 6Yj
Applicant's Address
Applicant's E-mail Address
vdr/,%e(?kAf fc#NJkcy)a, net
City S`l State CA-
Zip 41%J- Telephone 42Ci--6/y-ip2j,-�
ARCHITECT/DESKS NAME Last I-- — `--
First Lic. No. �-
Architect/Designer's Address
Architect/Designer's E-mail Address
_. -
city � State F_
Zip F— TelephoneF�
ENGINEER'S NAME Last
First F_ Lic. No.F—
Engineer's Address
Engineer's E-mail Address
city - -
State F_
Zip F— Telephoner -
\
CONTRACTOR'S NAME/COMPANY}/ n c Lic. Qg/¢�� Class ���
V /d�4Z
Contractor's Address
Contractor's E-mail Address
City-./TGIJSq State
Zip Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 11(�j I -.i.1'7/ .
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $