HomeMy WebLinkAboutX2022-1130 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application (57
City of Newport Beach - Building Division
Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL s
Building r Grading F-Drainage 9Elec )Meth
Plum Cu yd Cutl Cu Yd Fill
Project Address (Not mailing address) F_ Flood f Fire r Liq i— Landslide F_N/A Floor Suite No
1 501 Wes4Glix-a&, _ ��' - F
Description of Work
Use F Const Type
# Stories # Units (if Res)F_
Valuation $
Material/LaborF5/
New/Add S Re odel SF 3, 58-1 Sr- Garage/New/Add
p 8
OWNER'S NAME L st w2Cl%t t"� �il eH1Q/} Uk__
Owner's Address
er's E-mail Address
City w ` State CA
Zip Telephone
APPLICANT'S NAME Last nerPz.
First Yerl.
Applicant's Address
Applicant's E-mail Address
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1'31 8, NL Nit 4- ode br•
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City State C
Zip R"Z� Telephone -714 SOry-
ARCHITECT/DESIGNER'S NAME Last RC'f61tisa(N First Rckac_( Lic. No`JvC_1031
Architect/Designer's Address
Architect/Designer's E-mail Address
3195 3. A►v o(V _ Or,
,ro b nso(n (@rho1 . v)0A_
City �S� MX50 State I �
Zip q2/ �/_ Telephone 71-9,
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ENGINEER'S NAME Last
First Lic. No.1
Engineer's Address
Engineer's E-mail Address
City State �®
Zip Telephoned
CONTRACTOR'S NAME/COMPANY /� i
<
Y L Lic. No. q g l{ 66_] Class (3
�y�/
Contractor's Address /�i�trac
o 's E-mail Address
6)1 e14-
lc 9z_a , e .
City R { /6�� /, z.4 State e
(.�"C Y
Zip ?l v j Telephone-6
SETBACKS REAR SETBACKS FRONT
PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. Op,ya yY
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $