HomeMy WebLinkAboutX2021-1213 - Permit ApplicationPrint Form Worksheet for Combo Building & Solar Permitic'
F" Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTA
rBuilding r Grading
rDrainage i_ Elec r Mech r Plum CuvdCut CuvdFill F_
Project Address (Not mailing address) f— Flood I` Fire F= Liq F- Landslide F_N/A Floor Suite No
�7 iA E CGFl51- Hwy F_
Description of Work
Use L+I pMA� Const Type ✓;L➢
ft YfLATION N ! TtN6 G 11-To.,ea7e T6
# Stories # Units (if Res)l
(Vic
5
Material/Labor
-Valuation
New/AddSFF—
Remodel SFFi Garage/New/Add
OWNER'S NAME
Last 5061C9 IA10 First GA%D
Owner's Address
Owner's E-mail Address
�uvD►�-�1fiA�1
Ro 60� IdSb2
City %V40.11 (, uc.
State c A Zip gOZOq Telephone ) 4• ettS• GILT
APPLICANT'S NAME
Last A�W(� First ,0514
Applicant's Address
Applicant's E-mail Address
243117 M601TON
PRK W14'( Ia16a®eagS}At j �;nur nY ,nv t
City [LAM 11ILLS1fILLS
State �- Zip G��'37 Telephone C A •
ARCHITECT/DESIGNER'S NAME
Last Nfyf/OYV,4L 9,t/61NEE¢1nJG First �� Lic No.
C,- 2433'7
Architect/Designer's Address
Architect/Designer's E-mail Address
30 7'Namr1S
m
City I12VIN6
State CA Zip gMlk Telephone g4q,716.gyqp
ENGINEER'S NAME
Last Nd7-1DA/ EeVbf/16(nAJ First Lic.No. G L333�
Engineer's Address
Engineer's E-mail Address
3O 1-1}0/n
city (MvIN66
State I . — Zip I '?Ulf Telephone q4q,-ii6.gggo
CONTRACTOR'S NAME/COMPANY QU0, J4_ . 1 C n ���s j I i Lic No. I (_Ci i�qq Class [4, -
�L lam/
Contractor's Address
Contractor's E-mail Address
D
(7S S C l"`7
/ [ Zt�(1
City �jl��
State Zip C �'Z2 Telephone q D l'- t) )l�-�
SETBACKS REAR
SETBACKS FRONT PERMIT NO.
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $
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