HomeMy WebLinkAboutPV2022-0359 - Permit ApplicationPrint Form_ Worksheet for Combo Building & Solar Permit Application
o�Ew�Rm
r Comm'I [K Residential City of Newport Beach - Building Division ' �\ it P
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI AL
F_ Building r Grading r-Drainage r Elec r Mech
F Plum Cu vd cut Cu Yd Fill F
Project Address (Not mailing address) r Flood
r— Fire r Liq r Landslide rN/A Floor Suite No
21 Michael Place
I I
Description of Work
Use F_ ConstType
.6 KW roof mounted solar system
# Stories #Units (if Res)
New/Add SF F_Remodel SFF-- Garage/New/Add F_
Valuation $
Material/Labor
OWNER'S NAME Last ill Marbella LLC
First
Owner's Address
Owner's E-mail Address
21 Michael Place
LMarlin@Marlinmediation.com
City Newport Beach State Ca
Zip F2663 Telephone 14-313-6309
APPLICANT'S NAME Last Boersma
First Sam
Applicant's Address
Applicant's E-mail Address
5433 Broderick Ct
am@dmccorp.net
City Hemet State Ca
Zip 2544 Telephone 515708706
ARCHITECT/DESIGNER'S NAME Last First �—
Lic No.
Architect/Designer's Address
Architect/Designees E-mail Address
City F_ State F
Zip F_ Telephoned
ENGINEER'S NAME Last
First F_ Lic. No.F
Engineer's Address
Engineer's E-mail Address
City State F
Zip F_ Telephone
CONTRACTOR'S NAME/COMPANY
c Lic. No. B� Class c-10,13
i'121M�rrWtE ecvt s;�4L D�u�LoPm�nr 10770&7
Contractors Address
Contractor's E-mail Address
kCt 53(c✓v �u�rYG)eu05,,E 6,oC
. t s4-c✓e eLTGoeueloptvewr.
City Hemef- iVA l i-I / State Ca
Zip �o?�j�� Telephon 5957bS7d8'
-7111 -g313-&30/%.�/
SETBACKS REAR SETBACKS FRONT
PERMIT NO. q `/foil l _0 J2 /
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
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