HomeMy WebLinkAboutX2021-2329 - Permit ApplicationX2t)2( —Z32G1 � OcC^vt V1s
pint corm Worksheet for Combo Building &Solar Permit Application
City of Newport Beach - Building Division c Fop
r mm'I F9 Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) r Flood r Fire n Liq r Landslide r'N/A Floor Suite No
80 Ocean Vista, Newport Beach, CA 92660
Description of Work Use F_Const Type
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#Stories I #Units (if Res�l
Valuations F5OO�O�
Remodel SF Garage/New/Add Material/Labor
New/Add SF�-, �'
OWNER'SNAME Last W2G\Ok,Y'Z _ First
Owner's Address Owner's E-mail Address
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city
APPLICANT'S NAME Last 52 First
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Applicant's E-mail Address
Applicant's Address
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City State �— Zip �—:
Telephone �11 }) G03 - aglow
ARCHITECT/DESIGNER'S NAME Last V� C Ca Ykrl Archite First �/1 \\\ (IYYI Lic. No. �—
cttDesigners E-mail Address
Architect/Designer's Address
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City
State �— Zip �I Telephone t71q)3(2�j- lot 6-2-
ENGINEER'S NAME Last
First —�j Lic. No.F -
Engineer's Address Engineers E-mail Address
_ State F—' Zip �— Telephone_—
City ��
Lic.No. g15113 Classl "
CONTRACTOR'SNAMEICOMPANY
Contractor's E-mail Address
Contractor's Address J S2 2 r h C.5 \ • CA Yr
�� \' Zip G'ZiD Telephone (1l4 S03-b�iCo`�
15�0 S SU.ru�s�- a-e-
City a\ne YY\ State -
SETBACKS FRONT PERMIT NO.
FS REAR �—
�� PLAN CHECK NO.
S LEFT SETBACKS RIGHT
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DEVELOPMENT NO PLAN CHECK FEES $ �—