HomeMy WebLinkAboutX2021-1274 - Permit ApplicationX 2-OZI �
Punt Form Worksheet for Combo Building & Solar Permit Application—
F-, Comm'l FX-', Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
[X71ilullcllng [-Grading [-Drainage FXl Elec rX_ Mech fx- plum Cu Yd CutI N/A Cu Yd Fill [N/A F
Project Address
COLLINS ISLAND
address) r- Flood r Fire r- Liq r- Landslide r -N/A Floor Suite No
[N/A
Description of Work Use FsFD Const Type VB
INTERIOR REMODEL WITH FIXTURE AND CABINET REPLACEMENT, FORCED AIR UNIT AND WATER 1[ —
HEA I En REPtACEMEN 1 1 SOME VVAtt KEMOVAt, WINDOW AND DOOR REPtACEMEN I &ROOF # StoriesF2 # Units (if Res)(
DVDI ArCRACKIT F,
New/Add SFF8—,
Remodel SF P, Garage/New/Add
OWNER'S NAME Last
Valuation $
F_ (Material/labor;
111400 OD0.00
First FRANK & ALLISON
Owners Address Owners E-mail Address
17 COLLINS ISLAND
�
I
C NEWPORT BEACH State l6A
City F i _ _1 Zip 92662 Telephone (435) 640-1983
APPLICANT'S NAME Last
Applicant's Address
1613 1 ANAC I A PA DRIVE
City 1HUNTINGTON BEACH State CA
First
Applicant's E-mail Address
philnielsenOO@yahoo.com
Zip 92647 Telephone (714) 717-1418
ARCHITECT/DESIGNER'S NAME
Last I NIEL SEN First PHIL Lic. NoT
Architect/Designers Address
16131 ANACAPA DRIVE
City rHUNTIN GT 1 0 N BEACH State PA
Architect/Designees E-mail Address
FphilnielsenOO@yahoo.com
Zip 92647 Telephone (714) 717-1418
I
ENGINEER'S NAME Last JABARQUEZ FirstFio F51SE Lic. No. C9
Engineer's Address
18ELCORZO
City RANCHO SANTA MARGARITA I State A P
Engineers E-mail Address
lab - a I rquez@aol.com
Zip 9_2688 Telephone (714) 277-9895
CONTRACTOR'S NAME/COMPANYClass
Lic. No.
Contractor's Address Contractor's E-mail Address V, f77
City State Zip Telephone F W
SETBACKS REAR
SETBACKS LEFT
SETBACKS FRONT
SETBACKS RIGHT
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $