HomeMy WebLinkAboutX2021-1235 - Permit Application (3)Print Form_;] Worksheet for Combo Building & Solar Permit Application F? wQ#R
FX_ Comm'] r Residential Y20 2 1 S32 5_City of Newport Beach -Building Division Lfq ?S y„/ (U�l � ,
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding rGrading r,Drainage rElec rMech r, Plum cu vdcutF Cu Yd Fib
Project Address (Not mailing address) �: Flood rFire r Liq r Landslide rN/A FloorSuite No
,
, si �j,,� �VJ
`—
1 `/- - Vuv"t )
Description of Work
Use F_ Const Type F_
# Stories # Units (if Res)
,
Valuation $
Material/Labor
New/Add SFF Remodel SFL—�
Garage/New/Add (
OWNER'S NAME Lasb���.
First �
Owner's Address
Owner's E-mail Address
t
City Com, StateI Zip % Telephone
APPLICANT'S NAME Last lie L
First lv�
Applicant's Address
Applicant's E-mail Address
`2 2.v2 (,J v`)�vrhz-t' �-�
�^�'"�-a C'�-•-t�=(*,..�cia✓�.,�c-�
City ���" State ;^�
I o n r r I t..E�
'"t7
p 1 127o p 71L -a"7 -0q lv_7 ..
Zi G�o Tele hone
ARCHITECT/DESIGNER'S NAME Last )h (t1Le FirstSfi Lic. No. G(L
/q
0
Architect/Designees Address
Architect/Designer's E-mail Address
J t D Z U bvlii <lem Avg
City t F r /i y ve State
Zip Fit t vL Telephone jjj ) C � -7 >ZI Lj
ENGINEER'S NAME Last
First F Lia No. F_
Engineer's Address
Engineer's E-mail Address
City State w
Zip Telephone -- _
CONTRACTOR'S NAME/COMPANY } Lic. No. /" ' ° ^ Class
Contractors Address
Contractor's E-mail Address
y1ze Pi
ib P % �Et t lrr_�s v " S`f 7 w i hv,. J
City j'oy� i tiyn State `]
Zip SJJ Zj Telephone ;(��, ivl _ q t
SETBACKS REAR SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.