HomeMy WebLinkAboutX2021-2369 - Permit ApplicationPrint Form' Worksheet for Combo Building & Solar Permit Application
City of Newport Beach - Building Division Xq`.,r 5 Wq
F- Comm'I F- Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUB ITTAL 6
-ZBuilding r—Grading [—Drainage I—Elec F'Mech F_ Plum Cu Yd Cut Cu Yd Fill
Project Address (Not malting address)
Flood F_ Fire [ Liq F- Landslide I_N/A Floor Suite No
Description of Work Use[ Const TYp e F
( au K # StoriesF # Units (if Res)
Valuation $
New/Add SFF— Remodel SF F_ Garage/New/Add F— Material/Labor 34,900
OWNER'S NAME LastlC50L)�k mA,;, Firstl
Owner's Address Owner's E-mail Address
17 A5 _ �a�`c� _ Cq^� e✓' 1Df. 3 v
City ({OawAS _ �GNt�t State Zip
APPLICANT'S NAME Lastl �%utvt4ANtr
First'
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Applicant's Address
Applicant's E-mail Address
2�6S0
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City ( State GrT
Zip
9�5 3a Telephone C1S%, �Et
ARCHITECT/DESIGNER'S NAME Lastvyzl,yo
First
asSgv Lic.No.V736e0y
Architect/Designees Address vt G .
Architect/Designer's E-mail Address
1716X
State
City HUvJ
Zip iaTelephone7/t6r
JJ
Last
ENGINEERSNAME Vi
First Lic•No�'�Co
20e OUOS57/2
Engineer's Address CS S'Gi l 4
Engineers E-mail Address
/74 '.ct��� t4u�_- 4e_1r,7_
City
_t1V.
F0``�� State
V ! tt4w _ _
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Zip C77g , Telephone '7/y C/c/'7 // y5"
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CONTRACTOR'S NAME/COMPANY AX6 i2�S�oY�tUY�j Lic.No. lC9346?4q Classl l3I (VLG�
Contractor's Address Contractor's E-mail Address
9a ego n� S-�✓ze4
City LoLvLe 615'~r a State C Zip 2S �� Telephone cS(. `� /. ,Sf'i�F%
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
USEZONE
DEVELOPMENT NO
PERMIT NO.
PLAN CHECK NO.
PLAN CHECK FEES $