HomeMy WebLinkAboutX2021-1023 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit A plication
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F Comm'I F_ Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 1 0
F_Building F_ Grading r'brainage XElec r Mech r Plum cu Yd Cut CuvdFill
Project Address (Not mailing address) F_ Flood F_ Fire r— Liq F_ Landslide (N/A Floor Suite No
1301 QJ A I L- 5 V� F
Description of Work Use F—Const Type
N PVAIZ.L.�c i Izl � X91 c Irl fEx\lf59-(N g Vp(jIC-LIE-
# Stories # Units (if Res)s
-- —' Valuation
Remodel Material/La SFr $ bor)I
OWNER'S NAME Last )
First
Owner's Address Owner's E-mail Address
City _ _.. State r.--_—,,.. Zip r—._—_-.__ Telephone[—
APPLICANT'S
elephonerAPPLICANT'S NAME Last %4 6?,4F- First FF__? i_> i> y
Applicant's Address Applicant's E-mail Address
�-1°02 Gj�'p'M�`c';v.D �� ��•ygr���,r P�s,+�ie��}Inev�SCor
City EA 1<P. (-3 L.:54 t4 O State [ < Zip 9 Z! -32 Telephone (I S 1... --:)
ARCHITECT/DESIGNER'S NAME Last First F_
No. F-----'
Architect/Designer's Address Architect/Designer's E-mail Address
City State �— Zip F Telephone
ENGINEER'S NAME Last I First r---- --- Lic. No.r� —
Engineer's Address Engineer's It -mail Address
city State Zip Telephone
CONTRACTOR'S NAME/COMPANY �( Lic. No. I ib IZ Class FC -
Contractor's Address Contractor's E-mail Address
495 giP-Ch 5Trf-VY
��%�o�v +���5�ex �c�v�es'tefectYi c,, Gorv�
city E-A k� —P—L-5i I A Qtj L State c ZIP I 3 c) S I
` �/US my � y � , p Telephone
SETBACKS REAR
SETBACKS LEFT
USE ZONE
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. 1L° _9
PLAN CHECK NO..
PLAN CHECK FEES $