HomeMy WebLinkAboutX2021-1720 - Permit ApplicationPrint Form = Worksheet for Combo Building & Solar Permit Application
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F_ Comm'I Fl��Iesidential TZ'o City of Newport Beach - Building Division 1(0 o(Al 1-0VOCA
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL b �r (9
Building [Grading F -Drainage r.7 Elec F7 Mech r- Plum cu yd cutF Cu Yd Fill
Project Address (Not mailing address) F_. Flood F- Fire F- Liq F- Landslide FN/A Floor Suite No
126, 'Pul t-0 vtn t4, L/ C
Description of Work
Use F_ Const Type F_
# StoriesF_ # Units (if Res)
4
F1,
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Valuation $
Material/Labor
I F/o, a, o
New/Add SFRemodel SFGarage/New/Add F
F F
OWNER'S NAME Last Yev yj G First[
Owner's Address Owners E-mail Address
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City Ca A ii A- D* t_ r Y�StateFEX Telephone1
APPLICANT'S NAME Last First
Applicants Address Applicant's E-mail Address
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City State Zip._ 7-2); —Lr , Telephoner7ici) 71t-Irty
ARCHITECT/DESIGNER'S NAME Last FirstLic. No.
Architect/Designers Address Architect/Designer's E-mail Address
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City [(;AJ 6 13,—� V�-C (+ State Zip F(5�op q) W 4q 3 7
I TelephoneF
ENGINEER'S NAME Last -.7 4/qd ( FirstLic. No.F
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Engineers Address Engineer's E-mail Address
538 �GQCO C_tg(_,L_C-
State Zip TelephoneO'19) S21 - ocl/
city 7-0 Fe ,J�
CONTRACTOR'S NAME/COMPANYJOS rr., -7auc_T�,o A) Lic. No. 1(() 2 1,317_ Class ? C 27(
Contractor's Address Contractor's E-mail Address
9866 e YI)ru plvc1QSCdA1ST9Uc 7/ 0 000V&_ G� l
City State R)� zip F7,LT(, 3 Telephonerq,,q)
SETBACKS REAR SETBACKS FRONT PERMIT NO. \t
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. V,
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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