HomeMy WebLinkAboutX2021-1114 - Permit Application (2)X2o2j—nay
Print' Form" Worksheet for Combo Building & Solar Permit Application
(` Comm'I jR Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
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Project Address (Not mailings address) f- Flood
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Description of Work
Uses Const Type F
# Storiess #Units (if Res)s
5acNar6 �iar&eap< Remodel -40
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Valuation $
Material/Labor
New/Add SFF -- Remodel SFF—Garage/New/Add F —'
OWNER'S NAME Last V(�'(�Skah {JIS
First
Owner's Address
Owner's E-mail Address
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zip �Z�PCPC� TelephoneGyq.Va.4I
APPLICANT'S NAME Last UQIaShaYI�IS
First P'}er
Applicant's Address
Applicant's E-mail Address
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Peter@�-I�epnegw�p.car�
A
City Nel/,jp6*-3e-ocki State Cn Zip Q2.C.pCaL) Telephonekit}q,�2,,�49 -
ARCHITECT/DESIGNER'S NAME '^^
Last V 01 lJcd (,( First Pe� r Lic. No: G I5U �
Architect/Designer's Address
Architect/Designees E-mail Address
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PetC Cl i i -q nal. corn
City upland_.. _ State CA—Zip _
FqlIBto Telephone g g.M._11
ENGINEER'S NAME Last w h -Cr'
First 'ROV Lic. No. (:Jk< ,
Engineer's Address
Engineer's E-mail Address
IE(D II, N . ?US-Hrl Ave-
City riV\a11-etryl State CA Zip –`�FS0� Telephone I�l .(030 (olVa
CONTRACTOR'S NAME/COMPANYc
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6WV18'/Wvt'kle�" LiNo. Class
Contractor's Address
Contractor's E-mail Address
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City Netipo� T3egc(i State CA. Zip C,,7 cep Po. Telephone a Li�,gaa•� ��
SETBACKS REAR SETBACKS FRONT
PERMIT NO. III
SETBACKS LEFT SETBACKS RIGHT
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO
PLAN CHECK FEES $