HomeMy WebLinkAboutPV2021-141 - Permit ApplicationI` Phntl=orm Worksheet for Combo Building & Solar Permit ;Q Iication
r, Comm'I FS' Residential Cdy of Newport Beach - Building Division I.I "f I
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
kr.Building 17 Grading rDrainage 1—; Elec
Address
Description of Work
36 Vii r -fats 36
J_ Mech rPlum Cu Yd
f7 Flood I—, Fire f—j Liq Landslide
Cu Yd Fill
rN/A Floor Suite No
Use F—, Const Type
# StoriesF— # Units (if Res)F;
......._.. .... �J ___. T J •v- �y _/ �.r bVAl.4 WJia1 �H
Valuation $ 7
New/Add SF F_
Remodel SF F_
Garage/New/Add �!, Material/Labor 3
OWNER'S NAME Last I�Jfihc� First) lcrtp�('Ct
Owner's Address Owner's E-mail Address
lS 196x�y �ocrt5l _8.' EI'C-C-i t
City Ca ani ( State I (.� Zip 9%.6 2s Telephone fly 931-1650
APPLICANT'S NAME Last
Applicant's Address
..........C4rGvvLG�1....L0...71rC ._...... __. __ .)
City State I (!; ..
First) je_-p,V_
Applicant's E-mail Address
Zip �6� Telephone T 1 i z7? vv
ARCHITECT/DESIGNER'S NAME Last First-
----- Lic No.
Architect/Designer's Address
City State
Architect/Designer's E-mail Address
Zip Telephone�—
ENGINEER'S NAME Last First Lic. NoT.
Engineer's Address
City State F
Engineer's E-mail Address
......
Zip F—� Telephoned
CONTRACTOR'S NAME/COMPANY �_ r C _ Lic No.I020q-Y Class
Contractor's Address rO
`13y'1S_I3vst ntss _ 1'� l� __I)r. So [ �c I PCS
City 1e I?CCVLo,_ State
SETBACKS REAR SETBACKS FRONT
SETBACKS LEFT SETBACKS RIGHT
Contractor's E-mail Address
(� /C
Crrrtrisarcmo�e G r -r-00 W fCrW—'CI
:.0 vI
Zip 2J'T(!� ; Telephone-
--- - '
PERMIT NO.
PLAN CHECK NO.
USE ZONE DEVELOPMENT NO PLAN CHECK FEES $