HomeMy WebLinkAboutM2021-0078 - Permit Application (2)Pant Foam Worksheet for Combo Building & Solar PermiA rca
F_ Comm'I F Residential City of Newport Beach - Building Division o
- NOTE: PLAN CHECK FEES DUE AT TIME OF SU�DQTTQk I A //'1ML Q °`w°""•°
Building F_Grading rbrainage F_Elec F_Mech F- Plum CuvdXUt7 r CuuYddFill
Project Address (Not mailing address) F_ Flood F- Fire r Liq H/CUTndlWIW T�foo' Suite No
l..ado Swd
OF NEWPORT BEXC
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CITY
Description of Work
se 'Const Type
lR e-svw2 t Ir -Z Pl. 0..G II
#Stories #Units (if Res)
Valuational 060
30bor Fb i
Material/Labor
New/Add SF F_Remodel SF�
Garage/New/Add �
OWNER'S NAME Last L-Ijo lslc CV&,
dd First
Owner's Address
Owner's E-mail Address
701 dta L,d-0 S>.d
Get>o 1$t,
City wL a/1 State CR zip `f ZLL3 Telephone�yq. &73 bl7v
APPLICANT'S NAME Last &GW T41L Gcwtw%vwi
//
�}Sspt. First
Applicant's Address
Applicant's E-mail Address
701 V;A Li -do Sood
1-11>o 154t'r e (/i1ZAIr1A)i_ (,o Ni
City NEµ/ Dr1' 5&A State lif�
Zip glvl Telephone °lyq.(473• (4170.
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect(Designer's Address
Architect/Designer's E-mail Address
City State F—..
- Zip F_ Telephone.
ENGINEER'S NAME Last 7 Gtr v J
First pl av114, Lic. No. L ;(,,g97
Engineer's Address
Engineer's E-mail Address -
2$ILI omits fit•
F.PGt;-Uv& FMA-M,00m
City L.Awt^0.. NI1Je_i : StateriA..
ZiP .. ,qu77 Telephone _111'. 717•%Sy2- ___... ...
CONTRACTOR'SNAMEXOMPANY StieUmtiker�
I -4c,. Lic. No. 1 Class
Contractor's Address
Contractor's E-mail Address
837 W. 17tk Sf-,,4-
Skcllm,kc�E 5(r j,?6)j wit
City f r- PA State GA
Zip i;•,,2-7 Telephone 4q1 ,!514 6.53$1''
SETBACKS REAR SETBACKS FRONT
PERMIT NO. N W
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.—
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
N40