HomeMy WebLinkAboutX2021-2369 - Permit Application (2)Print Form„ ;9 Worksheet for Combo Building & Solar Permit Application
Comm'I
r- Residential City of Newport Beach - Building Division X�2�_f721n(i1
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL l LL ✓ lf� II c<;Fo •,
ZBuilding F_Grading (-"Drainage f-Elec F'Mech F Plum CuvdCut Cu Yd Fill
Project Address (Not mailing address) r- Flood F- Fire F- Liq F_ Landslide rN/A Floor Suite No
Sts
Description of Work Use F—Const Type
Yp I
1au # Stories[ # Units (if Res)r-
- - -- __-..- -- I
New/Add SFr— Remodel SF1__ Garage/New/Add F
OWNER'S NAME Last
Owner's Address
State
city (.�r(crwds___ 42trnc_�.
APPLICANT'S NAME Last
Applicant's Address
ASO_-"Aq-
city � CLY (Q�nd✓� _ State iirT
First
00D
Owner's
Owner's E-mail Address
Zip f?0r (;10 Telephonel
First
Applicant's E-mail Address
V. r
J� YPIdtr��@_aa'a-r�54V_C4,aAt,_I-01 --
Zip 9?5,3a Telephone qS-1,
ARCHITECT/DESIGNER'S NAME r
Last �U1Mf YD -_ First - Lic. No.
Architect/Designer's Address 6 3 K G ,
l7ltipr:E
city U✓I i vtq t otem N ac_k State Ctq
Architect/Designer's E-mail Address
Zip (a�r1 67 Telephone 7�
ENGINEER'S NAME Last �{ I' Z_ First9p b1_7.10 Lic.No. G ooS/,2
Engineer's Address D C.SF ; 4
174pp���1 ov
City V State GI
Engineer's E-mail Address
Zip O7 Telephone
CONTRACTOR'S NAME/COMPANY LiNo.g��jClass//Ofi(,L
Contractor's Address Contractor's E-mail Address
City GaVice- 6 j grxoY a -q State CYt. Zip 5-'3� Telephone
SETBACKS REAR SETBACKS FRONT 11 PERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $