HomeMy WebLinkAboutX2021-0119 - Permit ApplicationWorksheet for Combo Building & Solar Permit App�ic�tf `n
5� Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
dilding I Gradid'hg
F -Drainage f-Elec F-Mech F-plumCuvdCut I— CuvdFill F_
Foject Add!�ss (Not mailing address) r Flood F Fire F_ Liq F_ Landslide r_N/A Floor Suite No
Description of Work
Use ConstType
6ie_ w,&,,
J ryk_a�OcAc
11 ,
CC 1 t # Stories[— # Units (if Res)F—
CA
New/Add SF — --
Remodel SF Valuation S
Garage/New/Add r--'. Material/Labor 1
OWNER'S NAME Last a CQ/ First MrlkAe(
Owner's Address
r (OA64-
G
- - -- - -
Hl #� Owners E-mail Address
1tN - V-)OLJ 2c/ E_ US-owA HoMe5Mee A4A J. Covet
-7/--F-
a
City (-F7Y'Ovt� O f
�Cq / _ State F Zip I (s2 �... Telephone
2 9 I•723�3387
APPLICANT'S NAME Last°.2/A2�tKn First�f? W
Applicant's Address Applicant's E-mail Address
3111 Seeo�dl Ave 6nCle_ 1 'i�tCGrn�anK�J l5cAe&iec4-s. Ce,,,,,
City (.-O✓OVIq Je� /1/iw. State F5� Zip Gt'2GZS Telephone i49-G9S,9j$2
ARCHITECT/DESIGNER'S NAME Last '_First j__--._ Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address -
City -. -
State r—' Zip Telephone[—
ENGINEER'S NAME Last I&A,IDae I First_A i5k@ � Lic No. t> '(
Engineer's Address
Engineer's E-mail Address -
City COSi7l M2S.ti
State FCSE- zip[12621 Telephone 9qq' 6qn,
(75R6.
CONTRACTOR'S NAME/COMPANY Lic No. F_ Class
Contractor's Address
Contractor's E-mail Address
City
State F Zip r Telephone! -------
SETBACKS REAR
SETBACKS FRONT PERMIT NO. ✓�i� — �.,
`ETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. 14qq ,- ��"
�
'E ZONE
'7
DEVELOPMENT NO i7Pi Lam- Ly PLAN CHECK FEES $