HomeMy WebLinkAboutx2021-3226 - Permit Applicationprint Form Worksheet for Combo Building & Solar Permit Application "°^e
Comm'I City of Newport Beach - Building Division
I- Residential
NOTE' PLAN CHFCK FFFR Ill IF 0T TInnF nF ci iQnmrrni
F -Building F_ Grading
F -Drainage rElec F_Mech r Plum Cu yd Cut Cu Yd Fill F_
Project Address (Not mailing address) r== Flood r- Fire r Liq r- Landslide F_N/A Floor Suite No
Description of Work
Use [_ Const Type F_
#Stories #Units (if Res)
New/Add SFFA ,{ 14
----Gauge/New/Add
Remodel SF
-- -
Valuation a
Material/LaborIT)I �(n
OWNER'S NAME
Last/��� G�<•,� yr
� Y First ...
Owner's Address
_
Owner's E-mail Address
City �i'7/'.r � _
Stater C'/! Zip Telephone �%�G 2`GZ 5,7,f6._
APPLICANT'S NAME
Last�tiL��G
First
Applicant's Address
Applicant's Address
,/ LU.-.. /i'U7�- ��.. _.
,E-mail
T7C'� Ew'(�bG%�'%�u-7r✓'6zrr�.. � uz
CItY / Ip L�u�jaci✓� e1p--s-rr/�i- _ .. Statez,; ¢ -
Zip r , io Telephone &
ARCHITECT/DESIGNER'S NAME Last (_/�4` First Z- -
I
Lic No.
Architect/Designer'sAddress
Architect/Designer's E-mail Address
t�-7
`Z%O!/
City 2�iZ-, ieiki
State lid- -
Zip e7?6f 2Telephone';; �:7d jt2�-jU
ENGINEER'S NAME
Last
First `— Lic. No. F_
Engineer's Address
Engineer's E-mail Address
City
State F
Zip I Telephone)— -
CONTRACTOR'S NAME/COMPANY E.t S,l2t
Lic.No.�� Class GQeC f
Contractor's Address
Contractor's E-mail Address
Re,
e � Gc,7 f2 �f s ✓t f GOA
City t; v)v/, %W//7.
_ State C
zip /'2 5-2 Telephone �� Y:N
SETBACKS REAR
SETBACKS'FRONT
PERMIT NO. /` [%a� 6
SETBACKS LEFT
SETBACKS RIGHTT�
PLAN CHECK NO. G I� t b=/t
USE ZONE
DEVELOPMENT NO / �
r
. i f�1 � PLAN CHECK FEES $