HomeMy WebLinkAboutX2021-3298 - Permit ApplicationX2oz(-32q$
Print Form A Worksheet for Combo Building & Solar Permit Application
r Comm'I F_ Residential
City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
rBuilding r Grading rDrainage r Elec r Mech r Plum CuvdCut CuYdFill
Project Address (Not mailing address) F= Flood Is Fire F_ Liq r- Landslide FN/A Floor Suite No
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Description of Work
Use F—Const Type F_
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# Stories[— # Units (if Res)[ —
Valuation $
New/Add SF (��— Remodel SFr—- Garage/New/Add l-L29:_- -
Material/LaborboK
OWNER'S NAME Last PARK NE'-jF0rZ— First LP
Owner's Address Owner's E-mail Address
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City I;UI t�-�OYLI AC_t-4 State C/4 Zip �''l2GGC> Telephone y/s5 GS�i '
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APPLICANT'S NAME Last A 2— First SA M L=S
Applicant's Address Applicant's E-mail Address
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City 1.) State C Zip <J2.`C�v Telephonerlit.f�+ - ' 3 y , z3 �4
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ARCHITECT/DESIGNER'S NAME Last First r L Lic. No. C 4S
Architect/Designer's Address Architect/Designer's E-mail Address
City I LDfi)b State Zip �O JF Telephone � 4-ZD
ENGINEER'S NAME Last �— First r Lic. No.r
Engineers Address Engineer's E-mail Address
City State I Zip F— Telephoner_
CONTRACTOR'S NAME/COMPANY �yihas7 Cods-�rr+rah LLB Lic. No. (o3z jqq Classy
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Contractor's Address Contractor's E-mail Address
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City M S t,L State CT Zip 063S5 Telephone D60_57j g600
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SETBACKS REAR SETBACKS FRONT PERMIT NO. �2� _3 Zq0
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $
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