HomeMy WebLinkAboutPV2021-034 - Permit ApplicationV,V ZUzI -*4 19 7— vg cyr Svc
Print Foam Worksheet for Combo Building & Solar Permit Application avo
Cit of Newport Beach - Building Division
(- Comm'I r Residential y p 9 0
NOTE: PLAN CHECK FFFR nl IF AT TInnF nG ci iannirrei
FX -Building j Grading
,Drainage rElec F_Mech plum Cu Yd Cut F Cu Yd Fill
Project Address (Not mailing address) r Flood j- Fire r- Liq [_ Landslide [,N/AF�loor Suite No
i_
F_
Description of Work
Use F Const Type
a u es, Inver er # Storiesr2 # Units (if Res)r—
New/Add SF 531
Valuat]on $
Remodel SFr-- Gara a/New/Add [1,000F9 I Material/Labor
OWNER'S NAME
Last rivera FirstMassiel
Owner's Address
Owners E-mail Address
712 Poppy Ave
mrivera@gmail.com
City Newport Beach
State CA Zip 92625 Telephone 949-244-1811
APPLICANT'S NAME
Last Stablem First Sam
Applicant's Address
Applicants E-mail Address
2102 Alton Pkwy Suite B
sstablein@tesla.com
City Irvine
State CA Zip 92606 Telephone 714-496-0688
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. r_
Architect/Designer's Address
Architect/Designer's E-mail Address
City _..
... __.,
State �— Zip �-- TelephoneF—
ENGINEER'S NAME
Last First—Lic No. �J17Q
7 l c✓
Engineer's Address
Engineer's E-mail Address
i
City _...
State �— ZiP[_ Telephone( ----
CONTRACTOR'S NAME/COMPANY Sam Stablein/Tesla Lic. No. 888104 Class446
Contractor's Address
Contractor's E-mail Address
2102 Alton Pkwy
sstablein@tesla.com
City Irvine
State CA Zip 92606 Telephone 714-496-0688
SETBACKS REAR
SETBACKS FRONTG7t1 �Z` 0?j
PERMIT NO. C `�
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO. t7� W -L-\
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $