HomeMy WebLinkAboutX2021-0677 - Permit Application (2)' FriF,tFora j _','Worksheet for Combo Building & Solar Permit Application o�fiWro,m ':
City of Newport Beach - Building Division +�
Comm'1 Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL oa
rBuilding F[ Grading
g.. F_ � r Plum Cu Yd Cm Cu Yd Fill F
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Project Address (Not mailing address) Flood [ Fire !— Liq (-"i Landslide l -!N/A( Floor Suite No
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CoeouA 'NL H,42
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Description of Work
Use ConstType Vd3
it VElv10 (c) SPIRAL STA(k
# Stories # Units (if Res)r-
ot)�Dt Mo 4�. iZsPaRCE .
CE )Cau�2a¢AIL.s
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New/Add SF[
--- -- ---- --
Remodel SF 1 %8 — Garage/New/Add[[
Valuation $
Material/Labor
OWNER'S NAME
Last O6 First VIc?or,
Owner's Address
Owner's E-mail Address
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city t✓pQoua DSL MAR State GLS �j 6_ p ��lYq)a;8 1030----
---__—_ ZiP c5 2 S Tele hone
APPLICANT'S NAME
Last j.� o y(y First {n(i L LIS
Applicant's Address
Applicant's E-mail Address
,1030 S (G ASSELL_si
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city
-- - - - - - — -----------
_City State CA Zip qac Telephone(]1µ) o185^ fiScZ
ARCHITECT/DESIGNER'S NAME Last First F77777
Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
- -
city
- ---- -
State Zip F Telephoned
ENGINEER'S NAME
Last. APSNA2 FirstS1414wV Lic, No.If$�
Engineer's Address
Engineer's E-mail Address
17 U90ZAL
Shawn.rAnvalpe ��crnu l.car t
City
State GA ZIP qZ, D Telephone (q°fq) 413-496S
CONTRACTOR'S NAME/COMPANY Lic. No. Class 77
Contractor's Address
Contractor's E-mail Address
City
State F_77 Zip �— Telephoner
SETBACKS REAR
SETBACKS FRONT PERMIT NO. ✓J�< 03
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SETBACKS LEFT
SETBACKS RIGHTPLAN CHECK N y�el l�" \9