HomeMy WebLinkAboutX2021-3239 - Permit ApplicationPrint Farm
F Comm'I
Worksheet for Combo Building & Solar Permit Application
Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
,P<Building F_ Grading F-Drainage [Elec r"Mech
r" Plum CuYdCut F_ CuYdFill F_
Project A_ddress (Not mailing address) 1- Flood F_ Fire F_ Liq I— Landslide F_N/A Floor Suite No
�7 // (tom f7o Xr
F
Description of Work
Use IZ ConstType �_13
�0) (;EQ CC., LAO PATIO 2 71 S F, A(V N' Cf /
C &AQZ} t ROC 1�4/)1,
#Stories #Units(ifRes)F—
Valuation $
Material/Labor
New/Add SF ( 3 Remodel SF— Garage/New/Add
OWNER'S NAME Last etc see;
First (cyuC /YtI
Owner's Address
Owner's E-mail Address
City I ll,'L ,y-,U (30---.4 State Cj�
Zip �2[16 Telephone q](- T ^{c
APPLICANT'S NAME Last (Cl
First
Applicant's Address
Applicant's E-mail Address
2 i 3 t9 CpoCPht pZ # (d I
� UiQG IXMr2t -h+ _ C 4M
City I (Ii4&1A6d LS State
Zip--/Z%S� Telephone gLi4- �3 /OSQ
ARCHITECT/DESIGNER'S NAME Last �jK}(( y First�It�' Lic. No. (27 {0
Architect/Designer's Address
Architect/Designer's E-mail Address
DAoO(J (—H(La4 _ CCIV
City I GptGch i{4 t, C� S State FCAZip
Z(S Gl Telephone 0 s % 7 A' St
ENGINEER'S NAME Last �U(( j6( First j'Zf E Lic. No.�—
��3753
Engineer's Address
Engineer's E-mail Address
2 3C ZZ (}} C;40ia✓>a pr2 Zu /
City 1 Lct3 — State (,rl
Zip . (?'5E S _-3 Telephone 7/.f SZ/
CONTRACTOR'S NAME/COMPANY
Lic. No. Class
Contractor's Address .
Contractor's E-mail Address
r I, c
City �(� � \�� State FE�
Zip 1� Telephone -�
SETBACKS REAR SETBACKS FRONT
PERMIT NO. w 2 •32,��
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Z-1 Ojq 2 QZI
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $