HomeMy WebLinkAboutX2021-0525 - Permit ApplicationPrint Form 'Worksheet for Combo Building fir Solar Permit Application
( Comm'I Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
*ilding r Grading F-Drainage [ Elec F- Mech F- Plum Cu rd Cut Cu vd Fill F
Project Address (Not mailing address) F_ Flood F- Fire j- Liq j- Landslide rN/A Floor
_I3 1,0 Ca taAq _
of Work
41116K5WAL 04Y
New/Add SF I/
ig U4 l W b
awt't Ard .
I RemodelSFF-
7GV v�, C—
Garage/New/Add I ""'
Suite No
Use F—ConstType F_
# StoriesF_ # Units (if Res)[_
Valuation $
OWNER'S NAME Last I Nea First I K4
Owner's Address Owner's E-mail Address
_13f 0_ Ga(ap h/r I -,,
City /VOW p vl-T pUt/ State I CA Zip > a Telephone
APPLICANT'S NAME Last I X 0
Applicant's Address
zl oog b�jah 6f r
city WoII h4 state r (,f}
r7tn/s+��
First I IV\_ '
�
Applicant's E-mail Address
4M xu §)gU yt,cr,IC -cat
rp R�%8G/ Telephone 6 y6 -63 9'42 Lt�3
ARCHITECT/DESIGNER'S NAME Last ) U I (First Lic. No. F_
Architect/Designer's Address Architect/Designer's E-mail Address
?I off_ - OVA G"r r'tT X,4 5 ma I' am,,.
1VA c
City V�� State I V" Zip 9))i Telephone & W -83"j
If&?
ENGINEER'S NAME Last
Engineer's Address
City
CONTRACTOR'S NAME/COMPANY
Contractor's Address
City
SETBACKS REAR C
SETBACKS LEFT
First
Engineer's E-mail Address
Lic. No.F—
State Zip �— Telephoner 1
Lic. No. F— Class
Contractor's E-mail Address
State 7 Zip r Telephoned
SETBACKS FRONT z PERMIT NO. %C to U - 0 50S
SETBACKS RIGHT PLAN CHECK NO. i±a I - z0z l
USE ZONE
DEVELOPMENT -NO / M ZtJp(i _ b PLAN CHECK FEES $..