HomeMy WebLinkAboutX2021-2622 - Permit ApplicationPrint Form j Worksheet for Combo Building & Solar Permit AP lica on 64kil,
F_ Comm'I �_q s i 1 City of Newport Beach - Building Division x�o2g
(�� NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
r'Building Grading FDrainage Elec F_Mech F -Plum cuvdCut F_ cuvdFill � v
Project Address (Not mailing address) F Flood r Fire r Liq J— Landslide F_N/A Floor Suite No
.Z/1 L'brd CA 012602
Description of Work
Use Const Type
4 Stori s 1 # Units (if Res)F_L Valuation $
Material/Labor 2-010
New/Add SFF— Remodel SF /( rj Garage/New/Add �—
OWNER'S NAME Last o , First -Zwyx
Owner's Address Owner's E-mail Address
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City��`?�T ..�y%i a PfJ� State e ? ZiP C( 262 Telephone
APPLICANT'S NAME Last�First
Applicant's Address Applicant's E-mail Address
12322 c�rl��1n; vis �wl��t ;�1��
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City JYJL� l(�O�G\._. State C` � Zip �Z d�C j Telephone .:�732 -8 256
ARCHITECT/DESIGNER'S NAME Last First F Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip F Telephoned
ENGINEER'S NAME Last �* t v Vrv,� First �I/(Lic. No. C-(, A 6
Engineer's Address Engineer's E-mail Address
a�� t• t?�;rckl_a�. ��;�� �\ _ _ in�a � ��-DkU��sc�Q,c�m
City Q?Se(\ State e Zip wZi (2-\ Telephone u01ck-5r, 1 _111*6(1
CONTRACTOR'S NAME/COMPANY s Lic. No. D %o�cRo Class
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Contractor's Address Contractor's E-mail Address
[.0o W ��,n��C� v � l'vc�A�c ._ ;\Iev� Kl
�I`1�11�-u�ltl �A
City Sc �a _ �U\ State �41` Zip _ \� �0� Telephone �1 23(i ��L( ( j
SETBACKS REAR SETBACKS FRONT PERMIT NO. 7�2� 7i 6
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $