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HomeMy WebLinkAboutX2021-2126 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permit Application Comm I Reside , 2 � 2(o City of Newport Beach -Building Division 1,7- 50�d IT`/1(/ NOTE' PLAN CHECK FEES DUE AT TIME OF SUBMITTAL {Building f—, Grading F -Drainage XlElec Mech ! Plum CuvdCut F CuvdFill Project Address (Notmailingaddress) f—. Flood [— Fire F_. Liq F- Landslide F_N/A Floor Suite No 12 ��a��Prti W�o�9P �`�C Uv\�1ri, l� 2025 I Description of Work Use ConstType (Lr vh04�L 'vet .rh N�� C1.sJ a_'�'S TdSS "C�LFc #Stories #Units (if Res)F_I -.. - --- New/Add SF model SF I Garage/New/Add—! Re Valuation$ �5�, 06© Material/Labor .. OWNER'S NAME Last pyo ac*j First Owner's Address Owner's E-mail Address \2 Sn et P- 4A_Q (`- City 0 p,QA _NSI Vv��.(L _ StateC.t� ZiP (i v� _ --. Telephone -'1 t,t -1. 1 Ch__ 41 S \ 3 APPLICANT'S NAME LastFirst Sw� Applicant's Address Applicant's - 18 `\j,�caryC�• `�'� Secy--�+J�� C C6 i0 . � r'� -. City �QYQ-N`L.._.. ,State- ZiP_. g26'l� Telephone g -1'2_1I9-O'ib'5 RCHITEC SIGNER'S NAME Last Q "\_ First iA,,g Lic. No.C 27 t (o k+ Architect/Designer's Address Architect/Designer's E-mail Address 20 J0 N?Qv12 eAgQs``� o` Q,.^^ X I\ - CZ) "A^ -- City - ��� _ State �— Zip —, Telephone Q4lci - o -i -G404 ENGINEER'S NAME 'Last First r' . Lic. No.�—' Engineer's Address Engineer's E-mail Address city _... _-._- _.._- -State F TipF Telephone CONTRACTOR'S NAME/COMPANY SCS ls�NOa��`c� j vL Lic. No. \02�3�1% Class, Contractor's Address Contractor's E-mail Address �aoG%a7 C t,� State �� Zip LA",iq Telephone Q"tct-Zn61-roSb3 SETBACKS FRONT PERMIT NO. SETBACKS RIGHT !7 PLAN CHECK NO. l DEVELOPMENT NO PLAN CHECK FEES $