HomeMy WebLinkAboutX2021-2863 - Permit Application;hrint Form',_ �(�,W7�orksheet for Combo Building & Solar Permit Application
I- Comm'I F_ Resid'er5tiai t ni�'5 City of Newport Beach - Building Division (WIP ��1�( D✓
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F -Building r -Grading F -Drainage F Elec r'Mech
[7, Plum Cu Yd cutI
Cu Yd Fill
Project Address (Not mailing address) C Flood
r Fire f— Liq r Landslide
r":N/A Floor
Suite No
j tSoo 1416 fiLRA-)a -DE .
F_
F—
of Work
KZTCHL--,AC /2E oDECznXh
Use Const Type
?ZE7�wE.L 14f13-("69- r3ftTffgi-t . $- 'i'CAST EK- CLPS
# Storiesl— # Units (if Res)j
.......... __. .......... --
Valuation $
New/Add SFFO 6 Remodel SF 7q, Garage/New/Add
b Material/Labor 36 A
OWNER'S NAME Last I SCH /VE-M(S'- First rL k-Fl%?�E� )
Owner's Address Owner's E-mail Address
1800 ri 5Z . Newilbn-T b6AcFt
City E -
pop -T, 3.1 - - I State E,4 Zip 926& Telephone A9-5Do_0?_3y
APPLICANT'S NAME Last I M05 f1 'riga Q
Applicant's Address
City I it�o V SEJO State
First I RD
Applicant's E-mail Address
1/�f-0 aWEI)C5LGq R -CN • '45Dm
Zip Telephone 323-$$0 -Ckgq C(
ARCHITECT/DESIGNER'S NAME Last 1-4pS ftTRC;tA I First � Lic.No.
Architect/Designees Address
X6`695 Ak�o C_YLEEK 869
City�Zs,p -yt State FE
Architect/Designer's E-mail Address
�N� C)v�� D�slCaro �izcH .cow
Zip 9 ZC C Telephone[7 I`I _ <g3g,71(D Z
ENGINEER'S NAME LastsAmR9>4,gDLT! First ( 0:;iil)A1 LIC. NO. FZ
Engineer's Address
City State
Engineer's E-mail Address
...
Zip [ — Telephone[ , ,—
CONTRACTOR'S NAME/COMPANY ui d S Sa 4.tftlo. IV IdOt��, Class
Contractor's Address
l ri lo; be,�, Vow
City Cw a v' cti State C g
REAR SETBACKS FRONT
LEFT SETBACKS RIGHT
Contractor's E-mail Address
QQ�. �f�nr'•u.{ov-��yul�al�.u�+S.cJM
Zip 1 Jd �_Telephone 61) '3a .2 -..t.{ S (o
PERMIT NO. X2021 1 -7- 6 3
PLAN CHECK N0. U R S - Z02'