HomeMy WebLinkAboutX2021-1806 - Permit ApplicationX 22 0 21- vo c 2223 Lave -el( PL
Print Form I Worksheet for Combo Building & Solar Permit Application
F Comm'I F Residential City of Newport Beach - Building Division
NOTE: PLAN CHECK FEES DUE AT TIME OF SUBMITTAL
F_ Building r—Grading
rDrainage [_Elec I`Mech F—PlumCu vd cut Cu Yd Fill
Project Address (Not mailing address) r— Flood C" Fire F Liq f— Landslide rN/A Floor Suite No
Description of Work
Use F—Const Type F_
UeMal�h�
q
'� CT
# Stories[ # Units (if Res)
New/Add SFF
Remodel SFr-.— Garage/New/Add
Valuation$
Material/Labor
OWNER'S NAME
Last I LIC,Ij First 1 Lind �e_
Owner's Address
Owner's E-mail Address
City �
State F_ Zip F_ Telephoned
APPLICANT'S NAME
Last ¢ L,n.k n First I ,
Applicant's Address
Applicant's E-mail Address
{ L
5'J'� 3z,*A SV 'i hIT.
/A�
/I
City Ner„ p,,} qe.&c� State A Zip q.�_ Telephone 7l
ARCHITECT/DESIGNER'S NAME Last �— First F Lic. No. .7
Architect/Designer's Address
Architect/Designer's E-mail Address .i
3r Arrc�,.tcc(-S
ISI Or"I") D,
City c-,,+, o e i,
State cd Zip % a� ;L Telephone
ENGINEER'S NAME
Last � First F Lic. NofT�
Engineer's Address
Engineers E-mail Address
City I
State F_ Zip F Telephoned
CONTRACTOR'S NAME/COMPANY
� c� ✓� Lic No. j� a'73 Class
c
Contractor's Address
Contractor's E-mail Address
City r+t:,.�.,,�L- (;c„��
State Zip 9)uL3 Telephone—
SETBACKS REAR
SETBACKS FRONT PERMIT NO. z
SETBACKS LEFT
SETBACKS RIGHT PLAN CHECK NO.
USE ZONE
DEVELOPMENT NO PLAN CHECK FEES $
Q' Z�-(�) cZ