HomeMy WebLinkAboutX2021-3385 - Permit ApplicationPrint Form; I
Worksheet for Combo Building & Solar Permit Application
City of Newport Beach -Building Division X-10
F_ Comm'I F_ o
Residential
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMI I I AL
r—,Building F_ Grading F_,Drainage F Elec F_ Mech r— Plum Cu yd cut Cu Yd Fill
F -
Project Address (Not mailing address) F_ Flood F-, Fire F_ Liq f— Landslide FN/A Floor Suite No
f I V2 Ew, 62 ilt; T� 22 L)
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Description of Work
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Use FE7, Const Type 5T
ft StoriesF __ # Units (if Res)[7,
Valuation $
New/Add SF
Remodel SF Garage/New/Add Material/Labor
OWNER'S NAME Last E6wPgzs , First I i Fylq 'Ni 1E.
Owners Address Owners E-mail Address
100 441V�60 ; rI3
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City Lmlwp Statezip TelephoneFF/ I
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APPLICANT'S NAME Last I ol
Applicant's Address
City State
First
Applicant's E-mail Address pp
I e,
Zip Te
ARCHITECT/DESIGNER'S NAME Last Firstj NcOW Lic. No. .312-17
Architect/Designer's Address
State
City F
Architect/Designees E-mail Address
ZIP Telephone[
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ENGINEER'S NAME Last First F C, WI _61 Lic. No.
Engineers Address
I f -
CityF_ek
F I I�v V4 State
Engineer's E-mail Address
(lir
zipi -Telephone 11 2 f
CONTRACTOR'S NAME/COMPANY
bp5t,(N_ �frr,&(q s Lic. No. 1_770SZS'3Class [Clog
Contractors Address
8171 E.
City
State
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SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT
SETBACKS RIGHT
Contractor's E-mail Address
cmoYta, pacde5,-5.9.,C0 M
Zip F_4-_v3os Telephone[ 714-6%9-7-79�)
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PERMIT NO. 21 �)51G
PLAN CHECK No.
USE ZONE DEVELOPMENT NO _b2V24 - QUV� — PLAN CHECK FEES $