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HomeMy WebLinkAboutPV2021-169 - Permit ApplicationWorksheet for Combo Building & Solar Permit Application 'Residential City of Newport Beach - Building Division f (' NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITT�V�2�� ra ing rDraina e 9 r Elec °F�^^ Mech j- Plum i "Project Address (Not mailing address) F Flood r Fire Cu Yd Cut Cu Yd Fill r 3l i f r Liq f j Landslide [N/A Floor Suite No GOccs'�, �UZcvfaarf �— ---.,, Description of Work Use �I--/ . e f -UV /.s�/ � %OJ firi�n I -•°' const Type r 1710GLGi iS/ pr 607M e, 5 % SolCu (.Z,yff LfS I/a Ye- New/Add # Stories ( I 5 #Units If Res) SF 5#q, c� r Remodel SF�— Garage/New/Add �— Valuation $ OWNER'S NAME Material/Labor Last L�� First %°� Owner's Address LJ1161V Owner's E-mail Address city 1AV90 4 6Mi66 cezlG rp ��i% State � � �ecps •Ge APPLICANT'S NAME Last r>1 Zip 9� Telephone /�'��'LQ�S Applicant's Address First Map%,(�, Applicant's E -mal lAd✓✓dress 12.J -2 - 5fe 908f qo9 rnCl�q'1� City �ll� ///7Gc� State Fc —_ r---6�L P7 Telephone til i}_ Zip � g7iy Oj Telephone ARCHITECT/DESIGNER'S NAME Last Architect/Designer's Address First Lic. No. Architect/Designer's E-mail Address City State F— Zip F Telephone--' ENGINEER'S NAME Last Mallnfin 7 / First Engineer's Address - Lic. No. Engineer's E -mal Address r City _---- (� State f Zip Imo, Telephone—' CONTRACTOR'S NAME/COMPANY Contractor's Address "` �G �G Lic' No. lelzw,66 Class c l� W / /' �� Contractor's E-mail Address /LJhQ/ 2 �. r�-�e 9oq Cityah%L(�i/1)Cti State��P2/ywl-6 Zip q s� �e 'ciO�C4� IZTelephone 5,593-73 q3 y-9 ,t SETBACKS REAR — SETBACKS FRONT SETBACKS LEFT � PERMIT NO. P�v VV G I d SETBACKS RIGHT USE ZONE n PLAN CHECK NO. O P h DF\/FI nonnr.�r .._