HomeMy WebLinkAboutX2021-1080 - Permit ApplicationPrint Form
Worksheet for Combo Building
I— Comm'I (jr Residential g B Solar
Di Permit /` II
City of Newport Beach - pp CBtiOP1 o�aEWPo„e
NOTE: PLAN CHECK FEES DUE Building Division { yy ,
(kBuilding �` Grading T prainage t ec AT TIME OF SUBMITTALA-Zo? I —tog -'
I� Mech Plum °``°""
Project Address Cu yd Cut
(Not mailing address) f" Flood cu Yd FOS
_ Fire Liq I- Landslide I_N/A
2/J'O I Po W Ft _Tb n Floor-- Suite No
Description of Work ALF
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111
L� . ,
R�MolJF L (ryr-r-�—
W (N DO 6 U- Use Const Type
W� �' #Stories-- �
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New/Add SF /� 'VCTU/zf{L Irl# Units if Res)
Remodel SF �- Y
:QTY_-OGarage/New/Add r- Valuation $
OWNER'S �NAME Material/Labor
Last DOLL
Owner's Address First
SLIwN 6124
IS -0 I P0 P -T "T P Y lykE owner's E-mail Address
°ityK)WRDP-7 i34, q State ,tIPnK/I <<@,%y�Z(c
APPL.Zip �
Last
ICANT'SNAME ' 7-(00 D Telephone 7(
oi4 3�Z
Applicant's Address - First.
4Z MA CARTo t]p Applicant's E-mail Address
4-va. Sr ,4
city A/rxv p FO6 lVP
State t oM
ARCHITECT/DESIGNER'SNAME Zp - 2
L!(/ T
Last b6v elephone r4-gyj 7�
Architect/Designer'sAddress - First
41-7 Architect/Designers E-mail Address Lic. No.
vD-"
9 M�c��7yv2
cityA T - --
State
'gI' Zip
�Telephone
ENGINEER'S NAME �{
Last .��'�---
Engineer's Address -. - First D4M1 ,,--F_
Lic. No. � DVg�I
/- O
J l0 a LD N��OR I � � Engineers E-mail Address.
City ND4✓POR-T Y State�7o�iiC h
CONTRACTOR'S NAME/COMPANY Zip �� S ° Telephone
Contras Address Lic. No. /I T 3
� f Class
Contractor's E-mail Address
City
State I Zip
j -
I Telephone[-�—`
SETBACKS REAR
SETBACKS FRONT
SETBACKS LEFT
�_ SETBACKS RIGHT -- PERMIT ND. d 7 ti-� r rD-�—
USE ZONE `mow !d
DEVELOPMENT NO PLAN CHECK NO, D�®
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PLAN m 4i= ,, _