HomeMy WebLinkAboutX2021-1306 - Permit Application (3)Print Form 06-144–h!
1 Worksheet for Combo Building& Solar Permit Applicatioj�F_ Comm'I r- Residential !3 06 City of Newport Beach - Building Division : L¢ t=vl, ril6/i -
WITP� PI Ani ruery come m..m nT-rn• –, -
"Building r Grading (`Drainage F Elec r Mech
r Plum Cu Yd Cut- Cu Yd Fill
Project Address (Not mailing address) F_ Flood
Fire r- Liq F- Landslide r -N/A Floor Suite No
14 Twwiv, o -t 8&4
F (--
Description of Work
Use Const Type
�
Srat,rrrw'w� H 1 6 �c��3� RTtry
# Stories- # Units (if Res)-
Valuation $
•Q0p
Material/Labor � 019010
New/Add SF Remodel SF
I �� Garage/New/Add �—
_
OWNER'S NAME Last F�eh
First
Owner's Address:
Owner's E-mail Address
1+ T-44yvowt
CItY n/ (Il State -- ;.Zipl
Telephone l(l'1"94_5-Z9?er
APPLICANT'S NAME ' Last i ANA
First
Applicant's Address
Applicant's E-mail Address
25 Auwjuts, ate 3z3
luck &Aawp,•werV,A 9r p. tem.
City ZYJJ11e _ State r Zip f iloi Telephone fet1- Z;1 -)3s7
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ARCHITECT/DESIGNER'S NAME Last F
First I--- Lic. No. �---
Architect/Designer's Address -
Architect/Designer's E-mail Address
City State F_ ZiP.(-TelePhoneF-----
Y
lA Hi
ENGINEER'SNAME Last§�
First �tMl --�bo - Lic. No
Engineers Address
,Engineer's E-mail Address ''�
rlW_elr l+9 Y fo►Yl.
//yEqe.
2S �''�+NLN/ 7rMf$32l?
City 1Yt)/'-e State I ZiPF92hibTelephone
F* 22 ?ix
CONTRACTOR'SNAME/COMPANY
Lic. No.r-- Class
Contractor's Address
Contractdr's(/� E-Iddress
City F State F—ZiP
F__ - Telephone--__—
SETBACKS REAR Q SETBACKS FRONT PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $