HomeMy WebLinkAboutX2021-1066 - Permit ApplicationmV,,Mire Ur
Print Form Worksheet for Combo Building '& Solar Permit Application
F Comml r Residential City of Newport Beach - Building Division °
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
j�ildin
9 r Grading r"Drainage � Elec j- Mech
r Plum Cu Yd.Cut� Cu Yd. Fill
Project Address (Not mailing address) f- Flood r7 Fire r- Liq F_ Landslide N/A Floor
3 y �� / Suite No
rY _. Cc ✓ LIC _�� F.
Description of Work
Use Const Type
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C� �toriesr— # Units (if Res)
New/Add SFr----- Remodel SF Valuation S
Garage/New/Add r-- -- Material/Labor �� 6 (9 "
OWNER'S NAME / � 6
Last ( N AJ First
S S `°
Owner's Address
Owner's E-mail Address
city
State .� C _ Zip _.. .
.Telephoners ?CU -/s -
APPLICANT'S NAME � �"
Last I y < < ZL-U AJ � �ritui�C�yy First 3-6 AJ
Applicant's Address ' u `1.
Applicants E-mail Address
city -
State , - "'l Zip Telephone
ARCHITECT/DESIGNER'S NAME(((fff C'Y (7
Last_SS i (� First f -�-p-� --c CC LLL l
U" `� M ®,..`l Lic. No. e 7 /
Architect/Designer'sAddress V -ate
Archdect(Designer's E-mail Address
i
City State r--'-- Zip -�------- Telephoner_ - j
ENGINEER'S NAME Last jke5
r r7! �A First
Engineer's Address
w r/ bQ Lic. No.i�
Engineer's E-mail Address
city LG, J q
C l (L ((i State r--__.._ F� ;
J �1 I � ZlpI ((h Sf Telephone7�Y .3g-�-fis'Q Z
CONTRACTOR'S NAME/COMPANY g�
t lU'T L �cJ v N _.r(Pt ,VA/6 �Lic. No. (tClass(-—
Contractor's Address
Z Y �/ t Contractors E-mail Address f
City C(4 ✓' 1� ^� S a� J'C
U 4. �_ C Crs _ State - ZipG 6 Telephone 94ec/_ j
SETBACKS. REAR SETBACKS FRONT L
SETBACKS LEFT -----_ PERMIT NO.
SETBACKS RIGHT PLAN CHECK NO. - L
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