HomeMy WebLinkAboutX2021-2344 - Permit ApplicationPrinlForm I Worksheet for Combo Building & Solar Permit Application
F_ Comm'I City of Newport Beach - Building Division
r Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F-Building F_Grading jrainage F_Elec r-Mech Plum Cu vd Cut Cu Yd Fill
Project Address (Not mailing address) I- Flood r Fire r Liq F_ Landslide FN/A Floor Suite No
Description of Work
Use R - 3 Const Type `f
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# Stories # Units (if Res)
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IeGbf DL�'i� C61,i;�- � A1J7J Src+r�aGE nCxY7
Valuation $
Material/Labor
New/Add SF �6 Remodel SFF Garage/New/Add �(
W-64— 2223 --"rkcb ,Qwe-,/&S 3 t 3
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OWNER'S NAME Last �-Ap izls pu First
Owners Address Owner's E-mail Address Y"
Z60& i/�44 cin� 57 Oz_
City A)cfiJ(_bd2 j 06?}cm State Ctj Zi Telephone[ �L��tj
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APPLICANTS NAME Last �jf First P�
Applicant's Address C'y/,c{Applicant's E-mail Address
City CgPQrvf 1JG2 MfNZ State C� 4 Zip Cr �2r Telephone g F_;/S - 352-8
ARCHITECT/DESIGNER'S NAME Last C)(fLt%5� First G YAS%Ji//9 Lic No. G -27_cJSy
Architect/Designer's Address Architect/Designer's E-mail Address
2z32 � cGYrS� i/wy 5(j?E'B GG/ilGDS � CG �1RC/-/l?EG7 , GoM
City Gp �G Ff yG` /94, ,y State Zip 7? Telephone -7#'% 1'e-,3roa
ENGINEER'S NAME Last ,'/-/cfjt7,q, First Sre\_lE' Lic.No. Fi1qq
Engineer's Address Engineer's E-mail Address
Z�705 Z c.�rr»LU cs�y'�S"�'IL�4n.l0 -�r�� � ssz�C�Ise�N�'x�.us.c6��
City G,4GUpJA, N!lSvE - State U' Zip � Telephone cfgg- 546/-
CONTRACTOR'S NAME/COMPANY �'(J T lnS` f�GA` � TIC Lic. No. i S `L4�ClassF
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Contractor's Address Contractor's E-mail Address
4'i341 lvcf5�- Y,� zN__V.
City L�� co5�el State I CA Zip cl .S - 3L, Telephone (� `j
SETBAC S REAR SETBACKS FRONT PERMIT NO.
TpACK LEFT SETBACKS RIGHT_ PLAN CHECK NO.�s Z®2
lE E DEVELOPMENT NO PLAN CHECK FEES $