HomeMy WebLinkAboutX2021-1554 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application ®r01,SM1,!%j- Comm'I esidential City of Newport Beach - Building DivisionI
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F Grading i-Drainage F_Elec rMech
r Plum CuydCut CuvdFiu F
Project Address (Not mailing address) 0( Flood
r` Fire kLiq F_ Landslide I -N/A Floor Suite No
Description of Work
�2 �
Use r '3 Const Type I v
/2t7'10171�_ 2
#Stories #Units (if Res)
lJrw �G 2 aj2 Grr�
/2ct�F
New/Add Jg® Remodel SF '" 6/ Garage/New/Add F—
Valuation $
Material/Labor
OWNER'S NAME Last l�85uIE2
First slLt3
Owner's Address
Owner's E-mail Address
City I AL-, R_#27' 0�550E--& State I
Zip % �Z- Telephone 7)y.3g23
APPLICANT'S NAME Last S
�U 7/y
First ��-
Applicant's Address
Applicant's E-mail Address
C7NTHis9 cylGO� /fkGH/1i�T
273z G . psi H,,)y
City � V>`L 1f{2 State 3�'-3
Zip J2625 Telephone 7i�9_ 8 3 25
ARCHITECT/DESIGNER'S NAME Last CH//_05
First Gl j{i Lic. No. F'- u9e5
Architect/Designer's Address
Architect/Designer's E-mail Address
2732 e , CGK{5T �r> y
ccNicpsP�N/T��� • �7
City �� j State I Cq
Zip /1 2,,-25 Telephone •j;�_7/6 -9526
ENGINEER'S NAME Last '7� ��fzD
First Tc,/E Lit. No.F
Engineer's Address ,S� L,U�
Engineer's E-mail Address
G%5z (_<AHjA.)0 c,4P1SiQf rJo �� C 201
s(�v E • Czb"l
City r� �6U� State �
Zip 9�67 Telephone �Jt� y
/Class
CONTRACTOR'S NAME/COMPANY ll "L\ CiC2 �1u Lic. No. jQ)f% t3
Contractor's Address
Contractor's E-mail Address
c_iServicrj2�C, oWi
City COv^Y�CI State �'t/
Zip q,KJy Telephone %f<i_��56
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. ij(�j1 20 Z
USE ZONE T- —i - h01" DEVELOPMENT NO
PLAN CHECK FEES $ `L� -1?2
i3303 732 30 + 3
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