HomeMy WebLinkAboutX2021-0853 - Permit Application��W°°�
Print Form Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division
Comm'I (— Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
VTuilding r Grading (—Drainage r— Elec F Mech F Plum Cu Yd Cut F_Cu Yd Fill
Project Address (Not mailing address) (_ Flood F_ Fire f— Liq [_ Landslide I -N/A Floor Suite No
Description of Work
Use Const Type l�
}=� N �vO i sc�►J 01itl
t l_l 515,1 i3A Me— I l2! ST4ogo 3j 1 t 570,0 o 4j.,j
# Stories # Units (if Res)[
Valuation
Material/Labor
New/Add SF� Remodel SFGarage/New/Add �
OWNER'S NAME Last L,`t'flt-,j - %I c-i* 'P.Zq(,0 First F i,-E PPpN J
Owner's Address
Owner's E-mail Address
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City t ttYFOP—T 5EAC,4
State � , Zip j2biixj Telephonerl llfj 938 [Z.1_7
APPLICANT'S NAME Last
W iC-le—w"L't<" First r3j
Applicant's Address
Applicant's E-mail Address
Z.b 3 d 6 E: f0
5J i s (>:+� �kboSTv-t.S �'ltj . God
City o g&-,A N Gt
State I "T"' Zip 90505 Telephone 3 i6 -7sa gz23
ARCHITECT/DESIGNER'S NAME
Last T`�j�l�� First jZUSSEL. Lic.�to.
Architect/Designer's Address
Architect/Designer's E-mail Address
Z 3 SE PV L.V E19A
I& r-J1? tZuSStri--` C C�i t 3 ioN`T` >.l� R-.won.,
City �v�,RpNG
State C-1-A Zip Telephonelsw 56S IDS
ENGINEER'S NAME Last
�— First Lic. No.�
Engineer's Address
S
Engineer's E-mail Address J
City �
State �— Zip [_ Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. F __ __ Class F
Contractor's Address
Contractor's E-mail Address
City
State r-- ZipF_Telephoned
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SETBACKS REAR
SETBACKS FRONT L" PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $ V