HomeMy WebLinkAboutX2021-2304 - Permit Application (2)Worksheet for Combo Building & Solar Permit Application
F_ Comm'I F_ Residential
City of Newport Beach - Building Division (/V Z — ') h b�
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBM TTAL !I v
;; uilding r, Grading rDrainage F_Elec rMech F—Plum Cu Yd cut Cu Yd Fill
Project Address (Not mailing address) F_ Flood r— Fire f- Liq r Landslide F_N/A Floor Suite No
Description of Work mwa((/I
Use I— Const Type F_
# Stories # Units (if Res)F'
v.ric
act
h
+
nn
td • ,
//
�� LSC..-
Valuation $ /��{, �/t
Material/Labor v I T
New/Add
Remodel SFr Garage/New/Add
OWNER'S NAIll Last First Irn,
Owner's Address Owner's E-mail Address
s �� v�t� J o. _ i h_ G
City VUV n/I')/�'. ,a State Zip Telep e 7r� 7=��-32t r.�
,'1
APPLICANT'S NAME Last � ( G/� First O k rV
'° I
Applicant's Address Applicant's E-mail Address
12-1415 IS w r7n J v � ib - cm
_ Zo o
city /, n� State Zip[ Telephone $'7- 32-10
2
ARCHITECT/DESIGNER'S NAME Last j ?X p ILFirst I :,Q Lic. No.
Architect/Designees Address ArchitecVDesigner's E-mail Address
If6% N.C6a.el Ply' VVA 6--u2, ADS b -.e 0 An, ('fYr
City��lG� vU`-"". a.� State Zip 2 S I TelephoneL�.
.��, 322-0 4B4
(NAME
ENGINEER'S Last First(6 Lic. No.F_
Engineer's ess Engineers E-mail Address
sAdd
( �L
City n n-%� State � — Zip ' ��Ql Telephoner" 14- q 14, L j 19 .
CONTRACTOR'S NAME/COMPANY G LIC. No. F ;:�_ Class
Con ctor's Address Contracto E-ma\Aress
2I S I ; n,
�7n774 h
City p j _ tate 1 �.. Zip � �eP� Telephone 767, yy4�., 3Z 1 D
V2172•�
SETBACKS REAR SETBACKS FRONTPERMITPERMIT NO.
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO, PLAN CHECK FEES $