HomeMy WebLinkAboutX2021-1546 - Permit ApplicationPrint Form Wo ksheet for Combo Building & Solar Permit Application aEWP°Rr�
City of Newport Beach - Building Division
Comm'I �Vfiesidential �j NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
9L/FOQ�
ilding Grading Drainage [_ Elec Mech F Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood
F_ Fire Liq F_ Landslide f N/A Floor Suite No
915 wALgC s►D2EET
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Description of Work
Us: � � Const T e
w yp
F AMIN �oF-
_
# Stor es# Units (if Res)
--
Valuation $
Material/Labor
New/Add SF� Remodel SF Garage/New/Add
OWNER'S NAME Last
First
First �a6
Owner's Address
Owner's E-mail Address
a15 WALK rr s-r.
City I N6 PO12,*' State
Zip s-� f,G(o3 Telephone 90q—z27-239(o
APPLICANT'S NAME Last ��i2 l �PC•FZ
First M ((ot�6Lj*j6(F-IL--
Applicant's Address
Applicant's E-mail Address
172 LI ell a.r VISTA t;)evvL=
DES Cc JCce&a44-n0tQ ® &0,1AIL. c o,N+
City Iw 4 I 'R ((CV_ State
Zip g6(pp ( Telephone �Sb3)69 73y I
ARCHITECT/DESIGNER'S NAME Last
First Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
City State
Zip Telephone
t
ENGINEER'S NAME Last
First Lic. No.
Engineer's Address
Engineer's E-mail Yress C""' C/7✓
City I State
Zip Telephone
CONTRACTOR'S NAME/COMPANY iti11�1 bt:Za
!7�(brJS Lic. No. Class
Contractor's Address
Contractor's E-mail Address
{�
) 0 2 L( Mg�_4r N I sm Pwe t v c-
OctCo^1UC?9 & f44 nL� NJ ® �' ✓11 M L. 0,-1
City I �jt+,n),O State
Zip C]�(7D I Telephone C6,p
SETBACKS REAR SETBACKS FRONT
PERMIT NO. �(&_ — [,S't 6
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. L L} -7 s
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $