HomeMy WebLinkAboutX2021-0119 - Permit Application (2)Worksheet for Combo Buildin & Solar Permit p ic�tf `n t
9 pp
5( Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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�Ojef Add) (Not mailing address) F_ Flood r Fire r Liq [_ Landslide CN/AFloo—r Suite No
2�Pietl SE. GeorSe N�vjpbv-} )-eo_c�% I ll— _— F
Description of Work
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Zw
Use Const Type
New �Ji}� Wa1\g
5 - C)�l`r,
# Storiesr— # Units (if Res)F_
I r f
I
h_i�
Valuation $
Material/Labor r
New/Add SF F — Remodel SIF Garage/New/Add
OWNER'S NAME Last
4 CQ/ First r Mil krig l
Owner's Address
Owner's E-mail Address
3010 E. (0 -as _ Ifw #3 V,)a ( er Ev54-bm homesme rc.. MA_ I. cow,
- - -
City (fJt O O E Mcx State �� e7 rc O
- zip l2 �v 2 / Telephone T/{ 1 - 72 �j • -3-385-
-387
APPLICANT'S
APPLICANT'S NAME Last
First AVV)14w
Applicant's Address
Applicant's E-mail Address
3111 Seco,-_,k�.e
Clt I �ku�manK� ls4.ck�4ecis. cew,
City I Co✓oviLa. -4
State &A-- Zip G15- TeTelephone vi
ARCHITECT/DESIGNER'S NAME
Last F First F —Lic. No. F—
Architect/Designer's Address
Architect/Designer's E-mail Address
City
' State F_, Zip F— Telephone—'
ENGINEER'S NAME Last
(9�t�O✓�2 First /blic%Igg f Lic No. K 295'f
Engineer's Address
Engineer's E-mail Address
4 93 _ F. 2&"
P"
City CO %n�
State Zip In 27 Telephone
CONTRACTOR'S NAME/COMPANY
Lic. No. F — Class
Contractor's Address
Contractor's E-mail Address
City
_ State r._.—. Zip Telephone__
SETBACKS REAR
SETBACKS FRONT PERMIT NO. K -7-r)-71 — b L 1'91
LEFT
SETBACKS RIGHT
PLAN CHECK NO.
ZONE DEVELOPMENT NO 0,zC)!i k — PLAN CHECK FEES $
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