HomeMy WebLinkAboutX2021-2594 - Permit ApplicationPrint Form,; Worksheet for Combo Building & Solar Permit Application o�EWP
r Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailing address) F_ Flood (— Fire r tiq I— LandslideFN/ArFloor Suite No
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Description of Work Use F Const Type
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# Stories '# Units (if Res)
Valuation $
New/Add SF Remodel SF Garage/New/Add Valuation $ or
OWNER'S NAME Last IRJ;nlE COvOAn1y First
Owner's Address Owner's E-mail Address
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City 1iLJ; J� State rp Zip L1 Z�I Telephone Gly �_j yiDeo
APPLICANT'S NAME Last AAC k o First L. P nY A
Applicant's Address Applicant's E-mail Address
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City l�S _AtJ6EL�e7 State CA Zip Telephone 323 (,(p30
ARCHITECT/DESIGNER'S NAME Last First
Lic. No.
Architect/Designer's Address Architect/Designer's E-mail Address
City State Zip F Telephone—
ENGINEER'S NAME Last First Lic: No.F--'>
Engineer's Address Engineer's E-mail Address
City State F Zip � Telephoner
CONTRACTOR'S NAME/COMPANY111 1 t(:"5 c , Lic. No: S`�(i Class
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Contractor's Address 83 C,. r1S OA W P3 , V,.) Air 10 Contractor's E-mail Address
City�oC, AtJ` Ci Lc 5 State CA, Zip aOpa� Telephone 323_ 931-do6_a
SETBACKS REAR SETBACKS FRONT PERMIT NO. yny-( "— Z51 /
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO. X 7 ^ AZO Z�
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $