HomeMy WebLinkAboutX2021-2535 - Permit ApplicationX Io2I—� 3
Print Form Worksheet for Combo Building &Solar Permit Application 'I °"'e
Comm'I j Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL 4���oa�'
Building F_ Grading
rDrainage F_Elec F_Mech
F- Plum Cu Yd Cut Cu Yd Fill
Project Address (Not mailing address) r Flood
j-` Fire F_ Liq F_ Landslide rN/A Floor Suite No
r____
MW V6yM-F
Description of Work
Use F_ ConstType F_
# StoriesF_ # Units (if Res)
Valuation $
New/Add SF 2��
Remodel SF Gara a/New/Add " fMaterial/Labor
g �
OWNER'S NAME
Last Lel6o wn-
First (,�tot tiO
Owner's Address d 9,.rn
�l'�✓ _tom
61V' 6A��00
Owner's E-mail Address
--
�,elcl��l,2 �.wcai�. fort,
City NA/
State �G
Zip G(Z(ri TelephoneG�-5..�2
APPLICANT'S NAME
Last (r(, PLTZ j
First (A WJO,
Applicant's Address
Applicant's E-mail Address
1a04e.GUrti6-e- mat 1.644-,
City /4.. � (. ,,.
State
Zip Q'� b Telephoner (�. �a -$i�j Tom.
4
ARCH/ITTEE(CIT(/ADYESSIIIGNER'S NAME Last
Lic. No.
First F 6
ArchitectlDesigner's Address
Architect/Designer's E-mail Address
City �
State ��
Zip F_ Telephoned
ENGINEER'S NAME
Last
FirstFv Lic.No.1
Engineer's Address
Engineer's E-mail Address
City
State I-
Zip �� TelephoneF_
CONTRACTOR'S NAME/COMPANY (,G'-,lQ 17Gr(�/S �/IL Lic. No. jd35'{-G7f.� Cllaass�s
f
Contractor's Address
Contractor's E-mail Address 0-T 300 ( 0 4
101 Z l2e[
Ma✓ Lavtz
2--2$-23
City 1-1 13
State C �
Zip cl U q5 Telephone
SETBACKS REAR
SETBACKS FRONT
PERMIT NO. X Za ZL Z 5 35
SETBACKS LEFT
SETBACKS RIGHT
PLAN CHECK NO. ZI 6 - ZO'Z 1
USE ZONE
DEVELOPMENT NO
PLAN CHECK FEES $