HomeMy WebLinkAboutX2021-2706 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application
Comm'I ,� City of Newport Beach - Building Division of'4
- - esidential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
-Building - Grading -Drainage -Elec -Mech - Plum Cu rd Cut Cu Yd Fill F
Project Address (Not mailing address) [_ Flood - Fire - Liq - Landslide -N/A Floor Suite No
Z 3 2,9 C
Description of Work �� 1 ?j gI
Use F—Const Type F-
# Stories #Units (if Res)r
(
1 p l `9 ✓t 0r
Valuation $
New/Add SFF Remodel SF F—Garage/New/Add �—
Material/Labor FW
OWNER'S NAME Last 1 J3 q i._J 0 S First F2 &Cf f ji 0 Q
Owner's Address Owner's E-mail Addres
72/Z R 1 IZ f- co C
city o� (� M Lift S state C.
L Zip fJ "7?Q Telephone z) 72 `�'?3!
APPLICANT'S NAME Last � F}lZ. C) t) /�-,v� � First /C
Applicant's Address Applicant's E-mail Address
3z IL 2LA _ r-_( �-e "D rz_.
City Lp, A (,�2 40 >, State I � ' Zip 745 Telephone F� Z T72--(7 3 /
ARCHITECT/DESIGNER'S NAME Last (t C�3 /-f First X L ,(A6 Lic. No. F—
Architect/Designer's Address Architect/Designer's E-mail Address
� iiZ� l3r'olCl�o�(ow ,?ff Sor,�T)Lt(9Lgc eD ecO�
City SA-�-(-. -_ AnA - State C' Zip -�>? `I-Oy Telephone 71y 6Z2g.T(&
ENGINEER'S NAME Last v ,�
)(l FF O First C Lic No.F—
Engineer's Address Engineer's E-mail Address
I J Z o -13 t Do le i o o Cl/O- ;z G I-L C, K
City S q ,t_, 0 A u 7i State e Zip C Z 70 J Telephon( ti c 33127J
CONTRACTOR'S NAME/COMPANY b Lic. No. Class
Contractor's Address Contractor's E-mail Address
City State F— Zip j Telephoned
E "L1-aY13
SETBACKS REAR SETBACKS FRONT PERMIT NO. �Uzj •Z'10tQ 2101
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. 2�4��O2II
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $