HomeMy WebLinkAboutX2021-1493 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application o�EW�aa
F_ City of Newport Beach - Building Division XX22 �� 14g3 0
Comm'I Residential NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI490
F-v5-uilding F_Grading ("Drainage F_Elec j-,,Mech j - -Plum cuvdcut Cu YdFill l
Project Address (Not mailing address) F Flood F- Fire F- Liq F' Landslide F -,N/A Floor Suite No
C0574& "1*1 0IV a-7 C -0/a: 7
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Description of Work
Use ConstType�
# StoriesF # Units (if Res)[—
Valuation $
Material/Labor
New/Add SFF ---- Remodel SFF ---
Gara a/New/Add 1– -'
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OWNER'S NAME Last
First
Owner's Address
Owners E-mail Address
AK P40-1 lF-a mi o
City _ _. State r---- Zip Telephoned—
APPLICANT'S NAME Last /L�y�
First
Applicant's Address
Applicant's E-mail Address
235-67- 0 o &Wu - 0-30 7 /
City �S "t StateGL
Zip `�Z6 3 0 ' Telephone (-j q),3,q/-6N79
ARCHITECT/DESIGNER'S NAME LastF
0/�UL�c)
_ 'First ys guy � _ Lic. No.
Architect/Designer's Address
Architect/Designer's E-mail Address
�s G 2 vSa s�.a-�✓1; �-3U7 __. __.. __.
F,.=;tel. 1rLL•,, E��i; D,'SIc.V Q�rrltllc. CU ..✓"
City )Z_ JS M•__. _.. _ State...Cid._
ZIP. `%2 `h _.... _..
G `�� Telephone (7l<j)3raI.0)d
ENGINEER'S NAME Last ppSOG
First/�UfN / l7 Lic.No. C 611 ("3
Engineer's Address
Engineer's E-mail Address
City Qig4,V4,E' State c.
ZiP _ _Z,9Z 7 Telephone (7/'1)363.3585
CONTRACTOR'S NAME/COMPANYB_ Lic No. Flgqy3/ z Class 8-cx6
r,L4�4G"u/i� eon/: r2uLi7�',Y
8.',
_. c s .
Contractor's Address
Contractor's E-mail Address
(o 10 7 TL r'12-,0,qo 4LIF
City F_r1$il//�-Lg_ State ( d
Zip._ yL8$.o TelephoneaV9)273_960
SETBACKS REAR SETBACKS FRONT
PERMIT N0. X&99Z_� '-• I T l
SETBACKS LEFT SETBACKS RIGHT
- PLAN CHECK NO. 1,-,)
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $