HomeMy WebLinkAboutX2021-0065 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application / �0�w
r Comm'I Residential City of Newport Beach - Building Division x2 d21 �� e
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
wilding rGrading rDrainage r--,Elec r—Mech F-PlumCu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood r Fire (— Liq r Landslide rN/A Floor Suite No
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Description of Work
Use h v Const Type F
# StoriesF # Units (if Res)
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Valuation $
New/Add SF I�lo Remodel SF t to t Garage/New/Add
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Material/Labor
OWNER'S NAME Last LI IJt First byj p
Owner's Address Owner's E-mail Address
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City I �4.LWAOC -L State I P" Zip O(2(p(„tj Telephone 1 rr�
APPLICANT'S NAME Last A1.4 First I 1, 1 L,(—
LApplicant's
Applicant'sAddress Applicant's E-mail Address
.211" P 1 J- bn b _ _ �-+�E h�c��� d In ,60 k ,h�`�
City I m i,,54 t o-,, 1, Leso State Telephone g4CJ
ARCHITECT/DESIGNER'S NAME Last Ok es� First l �L L
� Lic. No. �In`l+`jcf
Architect/Designer's Address ArchitectlDesigner's E-mail Address
2"1 �`� t �01_��r�rJ �. rw-�,:h.,ocle. Ca. (A•u ,h�.1-.
Zip lio-1J Telephone F4q ag111
City I I n l7IlE"-_yo State F"_
ENGINEER'S NAME Last I C:) -IT--til .. C First y\ j r , Lic. No -7Z 19
Engineer's Address Engineer's E-mail Address
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City NZ1,,, 12�rt�_y PJB r�C la State F— Zip 9 Telephone "'310 � � a GI o9B
CONTRACTOR'S NAME/COMPANY �� �-0 Lic. No. 4'pL''--ly Class ]']
Contractor's Address Contractor's E-mail Address
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C 1/ n� hta State Fjcl Zip q'j(o1 Telephone '�7—h u J of
/AC REAR 1 SETBACKS FRONT PERMIT NO.
SETBACKS LEFT —� SETBACKS RIGHT PLAN CHECK NO. VU �,Q2I
USE ZONE Q (ii✓or %4 --DEVELOPMENT NO LTM" ?Z -(PLAN CHECK FEES $ eW