HomeMy WebLinkAboutX2021-0407 - Permit ApplicationPrint Form
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
Building - Grading r._Drainage j'�(Elec rKMech r Plum CuvdCm CuvdFill
Project Address (Not mailing address) i— Flood r Fire F— Liq F_ Landslide FN/A Floor Suite No
211 CP I N Lw(iOvfi G'a45# w; V e
-- - — ------ -- --- �- 2l((o
Description of Work
Use Const Type
</
r2Cyi,Lz1 "l011 OT 13WCViaVS Irftvt'®t- IIM ��.
#Stories #Units('
�LCG'FY/C4.1 YYK 'CG.Q (
1 G it�'� / �i � r ns I i'lR-C��
roof gip--w�`�-� "`r s��t�,_-R,*fVV-e
�-
New/Add SF[ U Remodel SF Zpp®, Pj{-
Garage/New/Add �—
Valuation 5
Material/Labor
O
OWNER'S NAME Last n• Iwl^u,L G®,
First '(��c�- 5V•e C(sir( CGI� V1„n
Owner's Address
Owner's E-mail Address OY
660 Jv1hoVA.{-lMA- � --�lrC
(�✓p,°e(i✓I9 i✓'vI lLe ",V<Y• Cavh
City �. w State
Zip F1 2(o 11- TelephoneA_Lfp 'lam 2,445
APPLICANT'S NAME Last ,ff..W.s
a O�
First D'�py� G 0 BOVJ.4 s
Applicant's Address
�Y'GG•lI'GGf�
Applicant's E-mail Address
�/� `s.� Q�
�10�rJ SCP.Lta�G n'�- Skt.• 2A0
F GC(t19,,C•PQ)pd✓�aVGG-riC�
City r� "74 A^ as _ State F—
Zip �i � Telephone Cl4
ARCHIT�ECCTT/DDE�SIGN`E_R'SN�AME v� L.. OV' Lic No. G'ZF(o7�2
Last C r/f.�i `First ^_ r 141...t
Da
_
rArchitect/Designer's Address„
I (ohs `c
Archite�ct/iDesigrneerr's Address
r
_
5,ccc, A-t^e !'D{,C' 2(�
IY 10 w C N . D ('J6vq,�.✓5 4•77 ,
o-t-jd fsrt State �—
City C(�a
Zip O/ Telephone rc1 4,C1 s / P, 1 3 c?
ENGINEER'S NAME' Last
First Lic NoF—
Engineer's Address
(City
Engineer's E-mail Address
State
Zip — Telephone
CONTRACTOR'S NAME/COMPANY V� �
�t
j c No.
t If51i9uL T G 11( Li
� NC
Contractor's Address
ongFc y�W lTt1G/f�--J/1(/c
Contractor's E-mail Address
City%y?0/o State CIT
zip CTZ�`S �j Telephone
SETBACKS REAR SETBACKS FRONT
PERMIT NO. ,
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK
USE ZONE DEVELOPMEN'N
PLAN CHECK FEES $
A.s
I oy5-D