HomeMy WebLinkAboutX2021-2255 - Permit ApplicationP,rint;Form:� Worksheet for Combo Building & Solar Permit Aji l i5oir�"oc`ro'°�
F- Comm'I r Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F Building f, Grading F -Drainage [_Elec F-Mech r Plum CuvdCut F Cu Yd Fill
Project Address (Not mailing address) C Flood F_ Fire F_ Liq r; Landslide [N/A Floor Suite No
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of Work
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New/Add SFr— Remodel
Use F— ConstType F_�,
# Stories # Units (if Res)
Garage/New/Add I F--Material/La
Valuation $
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OWNER'S NAME Last W o Lib First
Owner's Address Owner's E-mail Address
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City l..vPlb _.. State F c7or Zip. vt'Z666 , TelephoneF94
APPLICANT'S NAME Last I W Cl \10111 First
Applicant's Address Applicant's E-mail Address
City .. _... State �C�'Zip.._.gZt;b3 Telephone C�`{_rl��"Gb'"I�__. _.._
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ARCHITECT/DESIGNER'S NAME Last
Architect/Designer's Address
city _._.. _.._. State
_.. First)'', Lic. No.
Architect/Designer's E-mail Address
Zip F Telephone
ENGINEER'S NAME Last L G L I -c / First ° b V-
7 Lic. No.F6 C 5�
Engineer's Address Engineer's E-mail Address
City PPA eli-ervlrt..... State 6'�..... Zip -(ZK_�- Telephone �l`-(..._b3cJ-.(ta0
CONTRACTOR'S NAME/COMPANY�Lic No. Pvm Class 2� N S—t1+1✓'C L✓sv�� S�,A-pt. �VIC,
Contractor's AFdddress Contractor's E-mail Address
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city �f' �3 State e_r zip Gi'26 b 3 Telephone �f Y r1 S
SETBACKS REAR SETBACKS FRONT PERMIT NO. J% VV vl • wri i.n
SETBACKS LEFT SETBACKS RIGHT PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $