HomeMy WebLinkAboutX2021-3102 - Permit Application (2)„rtPnnt Form ,,,;1 Worksheet for Combo Building & Solar Permit Application o53`'° m
r` C m I j— Residential� 510 v City of Newport Beach - Building Division l�fs1 v
NOTE: LAN CHECK FEES DUE AT TIME OF SUBMITTAL G4 oa.
Building Grading (-Drainage [ lec rMech Plum cuvdcutF cuvdFillI
roject Address (Not mailing address) 1- Flood F_ Fire r Liq f— Landslide FN/A Floor Suite No
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of Work
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New/Add SFF-- Remodel SFESh I ( Garage/New/Add F_
OWNER'S NAME Last
First
Use Const Type
# StoriesF_ # Units (if Res)F—
Valuation$ F23Material/Labor
Owner's Address Owner's E-mail Address
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City WGw//dY% BoRGh StateFe—A Zip gZ65-1 Telephone IsI-Si83335
APPLICANT'S NAME Last I ,jhaye .5 1_1! )A
Applicant's Address
25626 Crown �1o4ey
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City I -” eVct a h e- n State F2EA
First) �Greid�ovl
Applicant's E-mail Address
Zip Q26�{Lf Telephone%y-`� 6�1;-3iCy[f
ARCHITECT/DESIGNER'S NAME LastFirst
Architect/Designees Address
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City Long! t3ea�j.� State C fi
ENGINEER'S NAME Last
Engineer's Address
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City State F
Architect/Designer's E-mail Address
-- -
Zip %0 803 Telephone X62 212 9434
First F Lic. NoT—
Engineer's E-mail Address
.- -
Zip Telephone
CONTRACTOR'S NAME/COMPANY I C 13 k.M6 , Inc
Contractor's Address
25626 62vwn t<,*lley v1y
City rtkfia &rje_h State �—
LIc.No. 15?CV.6 Class[—
Contractor's E-mail Address
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Zip q Q4 Telephone llrcl-P/Glk -art IJ -4 -
SETBACKS REAR z> I SETBACKS FRONT W PERMIT NO. *474Lk 30lot.....---
SETBACKS LEFT 0 t SETBACKS RIGHTO
w.�,w PLAN CHECK NO. 2�0 ♦ U"4
USE ZONE 5FL-' CS -12, -DEVELOPMENT NO CCW I-Q&0101!^�"LAN CHECK F"W k Bj ,%n