HomeMy WebLinkAboutX2022-0922 - Permit Application (2)Worksheet for Combo Building & Solar Permit Application
❑ Comm'I [ Residential City of Newport Beach - Building Division X W211-09
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
❑Building ❑Grading [;Drainage ❑Elec F]Mech [Plum CuvdCut C Cu Yd Fill
Project Address (Not mailing address) ❑ Flood ❑ Fire ❑ Liq ❑ Landslide ❑N/A Floor Suite No
qao �afaye�v� N�w��rf�e� 9a��3 7 n
of Work I t A Use F7 Const Type
�01 UGL e_ V-)f.W'VI-A SPD tICo
# Stories❑ # Units (if Res)❑
I
ValuationaerilLa
New/Add SFE -777 Remodel SF Garage/New/Add � Material/Labor
OWNER'S NAME Lastl vam a-#-L)r)
Owner's Address
City r� I`y1e State
First I 9&10r)
Owner's E-mail Address
Q avl Ctvta ovl r .C�r�
Zip Telephone a(2 • Ni3 1
APPLICANT'S NAME Last 1711n / of ck
Applicant's Address
S :!�• we -5 i" ❑. P-77 ° 77
CityI-W-Ae(WL State l� Zip
First I / /WM/
Applicant's E-mail Address /7
ARCHITECT/DESIGNER'S NAME Last1-77777 First
Architect/Designer's Address
City State 177
o .13 vbl
Lic. No.
ArchitectlDesigner's E-mail Address
Zip Telephoned
ENGINEER'S NAME Last { 70V First Lic.
Engineer's Address
��1� Cu 1 GSC
city State —
Engineer's E-mail Address
C�nsu fh @•Prnct- 9.cor"
Zip of / � Telephone Rl 1/_9_1 0C_2
CONTRACTOR'S NAME/COMPANY 111 — ellma-ker I
Lic. No. F67/ _3
Contractor's Address rrn el'O
City �p5 j y(�S G( State
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
Contractor's E-mail Address
6Aellma ke r.. lr i *e @ ftat /.c-o"Y'
Zip� a � o2 Telephone 9 qq, S -V 5 , 3 �
PERMIT NO. Y 7f� t� 01 Z--�
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO 0 ZO'%/ 0 ( -7 k PLAN CHECK FEES $