HomeMy WebLinkAboutS2021-0210 - Permit Application (2)Print Form Worksheet for Combo Building & Solar Permit A lication
F Comm'I Residential City of Newport Beach -Building Div��� 07010
NOTE: PLAN CHECK FEES DUE AT TIME OF SUB
rBuilding Grading rDrainage [Elec F'Mech F_Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) 1- Flood F_ Fire r iq r— Landslide F_N/A Floor Suite No
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ce 141
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Description of Work X ,'kC ►l�lOut, I p L
Use 5F D Const Type FV
#StoriesI # Units (if Res)
Val6rtion $ t,
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7 C Vl \ /L' `?P n VI ycv�
New/Add SF /) f 1� Remodel SF �— Garage/New/Add
Material/Labor
OWNER'S NAME Last S �GlYC3. First yL� CT VC,
Ownetr's Address Owner's E-mail Address
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City I °tee o. O rk State C Zip Telephone --77 [
APPLICANT'S NAME Last ti��First
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Applicant's Address Applicant's E-mail Address
3Z303 .b Z�cc ca
City J State C, Zip 2 (,'Z J Telephone flj LI cj�p j j 03
ARCHITECT/DESIGNER'S NAME Last F First F��'
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
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City State �— Zip 1 Telephoned
ENGINEER'S NAME Last First Lic. No.F—
Engineer's Address Engineer's E-mail Address
City State F_ Zip TelephoneF—
CONTRACTORS NAME/COMPANY o �Lic. No. lass ij - C��iSk «-� �K'Sk�Jf✓ IoH
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Contractor's Address Contractor's E-mail Address 6Q 6 cl 3
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City 'LSA `( - State G�� Zi ) Tele hone L C�
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SETBACKS REAR % SETBACKS FRONT d / PERMIT NO. ito t\ 7fJV_-7
SETBACKS LEFT l SETBACKS RIGHT PLAN CHECK NO
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $ t