HomeMy WebLinkAboutX2021-1230 - Permit Application (3)Print Form Worksheet for Combo Buildin & Solar Permit Application
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9 pp
F Comm'I K Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
Building Grading [—Drainage F_ Elec j Mech j Plum cuYdCut
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Project Address (Not mailing address) I_ Flood f Fire [_ Liq F- Landslide
27
Description of Work
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Cu Yd Fill
[_N/A Floor
— F_
Suite No
Use �- ?� Const Type
# Stories[ # Units (if Res)
q� Valuation $
New/Ad F �" I 1 Remodel SF Z,( oo 5F Garage/New/Add � Material/La
OWNE Last i{/% (/ 12 J2 P First /� / T L
Owner's Address Owner's E-mail Address /
City /) M State C A Zip � 2 &2_5 Telephone
APPLICANT'S NAME
Last I
Applicant's Address
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City S A,,
-ARCII4 -Er /DESIGNER'S NAME
First I � C-,)
Applicant's E-mail Address
State V Zip Fq iio v Telephonel
Last All c Ho L 5 /7 N First 7`(� N� Lic. No.
( /1 F7�
Arch itect/Designer's Address Architect/Designer's E-mail Address
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City State CC A Zip W;5 Telephone q 2-7c „ (3L%
ENGINEER'S NAME Last C F( a t" t r ftoSC � First S�d7- T Lic. No. C� 3 T y �el
Engineer's Address
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City ISc1_ Al State C: A
f011 C �
CONTRACTOR'S NAME/COMPANY
Contractor's Address /vli u.Z(V G � L Z
City jp'vra,�_
SETBACKS REAR
SETBACKS LEFT
USE ZONE
Engineer's E-mail Address
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i i'L( Ct 1 � • � erz�
Zip q' 0 Telephone 5J� 7 �/
Lic.No. f!�e4CI.34gClass,
l Contractor's E-mail Address
5�1 crlNSTQ��o N, Gd 69
State Zip �� Telephone ��(, f —',_S ep3
SETBACKS FRONT
SETBACKS RIGHT
DEVELOPMENT NO
PERMIT NO. ,1611 l s n
PLAN CHECK NO. U
PLAN CHECK FEES $ 2 I V 0_7 .V