HomeMy WebLinkAboutX2021-1720 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit Application
F_ Comm'I jt-'�Residential r 21%ZC - IT2-0 City of Newport Beach - Building Division 2,(0 foc*) } LavOol _
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building F-, Grading I—Drainage (-1 Elec F_,Mech F-PlumCu Yd Cut Cu Yd Fill
Project Address (Not mailing address) I— Flood r" Fire F- Liq f-, Landslide F_N/A Floor Suite No
VC
Description of Work 2 ✓ Use
Const Type
N 1 7Ae460o P6 710 L1`ojc-YL 115 SQ_FT
# Stories #Units (if Res)
Valuation $
New/Add SFF--,I Remodel SFF— Garage/New/Add F_ Material/Labor IO o o
OWNER'S NAME Last Neu First 3 AK) C'-'7
Owner's Address Owner's E-mail Address
2G -Pot ivy
7 _ _ Lor, -m _ 471U VF tV—,)6 la�y C (3 l (L. CGo
City ICO 4l, vd- HCl Mr;t- State FEX Zip c_?i 5 Telephone `jq) 5-624631z-
APPLICANT'S
62463Z
APPLICANT'S NAME Last First I �Fw Fpr�y
Applicant's Address
City S�q N i°rNyk State 13
Applicant's E-mail Address
wtwgy ZO Econ 741,;,r i
Zip L( Telephone(ty)7R(-grety
ARCHITECT/DESIGNER'S NAME Last 2 First '
i_ OW-S7c S -.l M ( A/ _. Lic. No.
Architect/Designees Address
2 IsoAve.
City �;A)G �3,=._t State I �\
Architect/Designer's E-mail Address
R064- ,Fs. (2 GPtq/4/L_ .CGS
Zip 3O(, - T_�I Telephone5t.Cl,W?— 8137
ENGINEER'S NAME Last First-- Lic. No.
Engineer's Address
_538 _VGcCo cl g�,LE
City EO 4_0 J� „ State
Engineer's E-mail Address
p�Go®21�tkw 1@ y(Ghc9e. Cew1
Zip IZ� U TelephoneQ 10 52 1 _ t7q
CONTRACTOR'S NAME/COMPANY los ro,%T-,,rauc_T,,oA) Lic. No. ( -2_(O 177- Class Fg, C27�SJ
Contractor's Address
s�eto�U
City 4 vER S r DC State I CA
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
Contractor's E-mail Address
(PSCOA.)ST
._KUC..71 o 000
Zip TelephonQ4`l'ZSoy 3G•
�SZ�
PERMIT NO.
PLAN CHECK NO. 1\7% 1 c_
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $