HomeMy WebLinkAboutX2021-1882 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
r Comm" Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
�c Build'ng Grading (-Drainage r(Elec xMechPZ Plum CuvdCut F9CuYdFill l L�
Project Address (Not mailing address) F_ Flood F_ Fire F- Liq F= Landslide N/A Floor Suite No
Description of Work
Use ConstType
1 ' 'tJ
L
���Y.SI Y l./C � 611 •'
# Stories3 # Units (if Res)
Valuation $
Material/Labor CT 04 0,1/d, —OWNER'S
New/Add SF Remodel SF � Garage/New/Ad (-C)
NAME Last
First L o'
Owner's Address
Owner's E-mail Address
t d % L Gt (c&E V,icI
� �EGt ry () I2 iiPti. ,tG, �t
City L �C
State �+� � Zip Ci 2 Telephone
Telephone
APPLICANT'S NAME Last (7'67 First (_ /pJ
Applicant's Address
Applicant's E-mail Address
1 L 3
/3 r� c A,. 6' 9:�- 4c , (eeT-h4
City C n
State Zip z� ^��" Telephone G v-r1 -20 1
v
ARCHITECT/DESIGNER'S NAME
Last /,C First L4{Cyl� Lic No. �`_ jJ
f1
ArchitecUDesigner's Address
Architect/Designees E-mail Address
�� (e ), Ie
I /�f L( LOS (r; Ar(Am�r`V�iG L'o�ll
City F_z_c S
State F6ii Zip ,,�4 TelepW'�hone 7._22t •-2-7�/
art'
ENGINEER'S NAME Last5l�.. First�,i Lic No. _6�
s� 7
Engineer's Address
Engineer's E-mail Address
l 7 (6 zezt
City (=004; f(
State (_A Zip �j 2. G� C� Telephone
CONTRACTOR'S NAME/COMPANY L /N d C lW(i�, 7A- c- Lic. No. �1 VC 3 7 Class /�
/
Contractor's Address
Contractor's E-mail Address
�65�G l/// /Jl vet .
Sfe J f� carat
City f,,u.ti7f��h V1(f --
State F— Zip ..�2-7,J� Telephone 6( q_�J//G////`���� `J-U
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
�1
DEVELOPMENT NO V Z��� • O�JgI PLAN CHECK FEES $ dam^