HomeMy WebLinkAboutE2021-0410 - Permit Application_11 i3 (v'1 . U U ! U
Print For Worksheet for Combo Building & Solar Permit Application
F- Comm'] r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL.
rBuilding r Grading I -Drainage I-Elec r Mech F- Plum Cu Yd Cut Cu Yd Fill r
Project Address (Not mailing address) F Flood F_ Fire F_ Liq f- Landslide FN/A Floor Suite No
Description of Work
Use F—Const Type
# Stories # Units (if Res)[—
es)[Valuation
_
Valuation
coNew/AddSF
$ Flo,
RemodelSFF
-�— Garage/New/AddyMaterial/Labor
OWNER'S NAME Last Ca
First FT t d
Owners Address
Owner's E-mail Address
330 0�C_0 po(-+n
'f /
City �) r « v. .V ', i,<.,c � _ state I Lllk
Zip 'r._' 2 ' 2 Telephone509 _ 6,5 - 3 -,-,) i
APPLICANT'S NAME Last 7 E ���
First
Applicant's Address
Applicant's E- ress
Lit/t swW~Tf t ��IJ ;
1,z3 ;2,3e
I/G , 1°FJ A n e �, C042,901,
42,9 01,J, Le-14,Le-14,City
8'ISU` %sig.. (. State �.G%!.
)1 a
Zip Z,( 3C3 Telephone 0
ARCHITECT/DESIGNER'S NAME Last
First F Lic. No. F�—
Architect/Designees Address
Architect/Designer's E-mail Address
City I State —.
Zip F_ Telephone—
.ENGINEER'S NAME Last �—'
First [_ Lic. No.F--
Engineer's Address
Engineer's E-mail Address
City State r
Zip �— Telephone—
CONTRACTOR'S NAME/COMPANY Lic No. [97S j Class
?jYi-!..Jl / 1��. C-tri9v 9'UC�] d�?�f k� e� • 4 {7
Contractor's Address
Contractor's E-mail Address
q ^�
/�✓Gd1%7�/ifDtyp27�i
J
��YLCity
MZ66L
l/, C% State rr Ll
Zip Telephone F,1473g1 / z -1,L
SETBACKS REAR SETBACKS FRONT
PERMIT NO. 1E::�'WZJ
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO. 1 57 q - Zo z'(
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $
1;-c�CC)'7SEl S