HomeMy WebLinkAboutPC2022-2772 - Permit ApplicationL.
PrimIFEmLj Worksheet for Combo Building & Solar Permit Application HEWS,
F Comm'I j— Residential City of Newport Beach -Building Division �
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL S a� a� - �a 33 _
Buildin � o "
g � Grading Drainage .Elec Mach j` j��'`
j�PIUm Cu Yd Cut Cu Yd Filll
Project Address (Not mailing address) f- Flood f- Fire f - Liq f- Landslide FN/A Floor
"C" 72_ �e, r (- ��� Suite No
Descriptio
�� �i ✓ '� i G ter, Use ype
Const T
# Storiesr— # Units (if Res)
r—
New/Add SF t1 - L, Remodel SFr_- Valuation $
Garage/New/Addy Material/Labor �' Z "�'
OWNER'S NAME Last tIA-m s
First ii:;i r' ` lc�
Owner's Address -
-` S CJ -2- Owner's E-mail Address
City r - _ State
t Zip= Telephone
r7/9
APPLICANT'S NAME Lasvac
�JC 11 V15 Gi�y First
Applicant's Addresst ^
Applicant's E-mail Address
City State (_/}
Zip cum Telephone
ARCHITECT/DESIGNER'S NAME 9
Last First F —
Architect/Designer's Address Sim -'"I � y�—_S Lic. No. I
Architect/Designer's E-mail Address
City State F_
I Zip Telephoner --
ENGINEER'S NAME Last C /{
First Tc%-:7 Lic. No. &-%
Engineer's Address
2 Iv Zt�sa'��v AV r-x Engineer's E-mail Address
-... ... V
City ,.� � —
State (f} Zip Telephoned
63"- 6/oo
CONTRACTOR'S NAME/COMPANY
j ✓�i l� rl pp C Lic. No. %O�> °i33G Class G 1
Contractor's Address 3
Contractor's E-mail Address
- 0 T-O l? 1. vim" i-t'v w ,y. YY. V 0 I"-.
City �� ��� State C,
Zip ) L��° Telephone -'O
ail 7/ 4- 7 /4- 4zv
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT IT NO. Z
SETBACKS RIGHT
USE ZONE PLAN CHECK NO.
f1F\/FI nnnnrnir nin